Rehabilitation, Behavioral, and Multidisciplinary Care
Core concepts
Pain management is multimodal. Understand graded activity and functional restoration, physical and occupational therapy roles, cognitive behavioral therapy, acceptance and commitment approaches, pain neuroscience education, and interdisciplinary programs for chronic pain. Behavioral screening identifies catastrophizing, fear-avoidance, and depression that predict poor procedural outcomes.
Integration
Interventions work best when paired with active rehabilitation and psychological support. Know the difference between passive (injections, medications) and active (exercise, self-management) strategies and why chronic pain requires both.
Traps
- Expecting a procedure to fix a problem driven by deconditioning and fear-avoidance.
- Ignoring psychological comorbidity as a modifiable prognostic factor.
- Recommending bed rest instead of graded activity.
- Treating multidisciplinary care as a last resort rather than a core strategy.
Worked rule of thumb
Before escalating to an implant or repeated injections, ask whether the patient has had a fair trial of active rehabilitation and behavioral care. If not, that is often the next step.
Communication
Set functional goals with the patient; measure improvement in activity and participation, not just pain scores.