What Is Integrated Pain Management?

Integrated pain management is a single treatment plan that combines several types of pain care, delivered by providers who coordinate with one another about your case instead of working separately. If you have seen several providers for the same pain and none of them seem to compare notes, that coordination is the piece that has been missing.

Why Does Integrated Pain Management Use More Than One Treatment?

National prescribing guidance supports combining treatments. The Centers for Disease Control and Prevention’s 2022 opioid prescribing guideline calls a multimodal and multidisciplinary approach critical, meaning several kinds of treatment from several kinds of providers, attending to both physical and behavioral health.

For subacute pain (lasting one to three months) and chronic pain, the guideline prefers nonopioid therapies. It asks clinicians to make the most of nondrug treatments and nonopioid medicines, and to consider opioids only when the expected benefits for pain and function outweigh the risks. These recommendations are written for clinicians treating adults, so any change to your own medication is a decision to make with your provider.

The Building Blocks of an Integrated Pain Management Program

The federal Agency for Healthcare Research and Quality (AHRQ) set out a working definition for its 2021 review of these programs. Integrated programs were centered in primary care, with built-in or easy access to providers from several fields, and at a minimum offered:

• Medication management: Review or management of the medicines used for pain.
• Psychological care: Mental health services as part of the plan.
• Physical reconditioning: Physical or occupational therapy to rebuild strength and function.
• Care coordination: Case management or another formal way for providers to communicate about each patient.

AHRQ called similar referral-based programs outside primary care “comprehensive” programs. In the final review, both program types improved function in the short term compared with usual care, and serious harms were not reported, though the evidence on harms was insufficient.

How Is Integrated Pain Management Different From Interventional Pain Management?

Interventional pain management is a group of procedures, such as epidural steroid injections (anti-inflammatory medicine placed near the spinal nerves), nerve blocks, radiofrequency ablation (heat used to disable pain-signaling nerves), and spinal cord stimulation. Integrated pain management describes how a whole treatment plan is organized. A procedure can be one part of an integrated plan, working alongside medication, therapy, and mental health care rather than replacing them.

What Does an Integrated Pain Management Plan Look Like?

Picture someone whose low-back pain has lasted six months and has not improved with rest and over-the-counter medicine. An integrated plan for that person might bring together:

• Medication review: A look at which medicines have helped, which have not, and whether any should change.
• Physical therapy: Exercises to rebuild strength and movement.
• Procedures: An injection or another procedure aimed at a specific source of pain, when one is identified.
• Mental health support: Coping skills for pain that has started to affect sleep, mood, or work.

What makes the plan integrated is that each provider knows what the others are doing, so the pieces can be adjusted together when something helps or stops helping.

How Can You Tell Whether a Program Is Truly Integrated?

A few questions can show whether a practice’s providers work as one team:

• Who is on the care team?
• Are medication management, mental health care, and physical therapy offered in one place, or referred out?
• How do the providers share updates about a patient’s plan, and how often?

When Should You See a Pain Management Specialist?

Pain is considered chronic when it lasts longer than three months or longer than the time in which you should have healed. Treatment may not get rid of chronic pain, but it can help with your symptoms, so persistent pain is worth raising with a pain management specialist.

Ask About Integrated Pain Management in San Antonio

If you have already tried different treatments and pain is still part of every day, a coordinated plan is worth asking about. At Pain & Spine Physicians of San Antonio, our providers build individualized plans that may combine medication, interventional procedures, and physical therapy, with therapy available in-house through Therapy Associates of San Antonio. Call [phonenumber] or contact us to ask how integrated pain management could fit your care.