Behavioral, Physical, and Multidisciplinary Pain Management
Function-focused rehabilitation
Chronic pain management is multidisciplinary: physician, physical and occupational therapy, psychology, nursing, pharmacy, and vocational support. CBT targets catastrophizing, fear-avoidance, and maladaptive beliefs; acceptance and commitment therapy builds values-based activity; mindfulness and relaxation reduce arousal. Graded exposure and graded activity replace rest until pain-free with quotas and pacing. Physical therapy addresses strength, flexibility, endurance, and movement confidence; passive modalities alone rarely change outcomes.
Operant conditioning reinforces well behavior and avoids excessive attention to pain behavior. Sleep, exercise, weight, and substance use are modifiable factors. Multidisciplinary pain programs improve function and reduce disability in selected patients.
Traps: bed rest is harmful in most musculoskeletal pain; no pain, no gain is as wrong as stop if sore. A pain score of 0 is not required to progress. Psychological treatment does not mean the pain is imaginary. Opioid reduction should be gradual and collaborative.
Worked example: a patient fears bending. Set a baseline of 5 gentle bends, then increase by about 10% weekly; reinforce completion, not pain level. Rule: start below the flare threshold and progress by quota.