Multidisciplinary, Rehabilitative, Psychological, and Professional Aspects
Biopsychosocial care
Pain care is biopsychosocial. Biological, psychological, and social factors interact, and treating only the nociceptor often fails. Interdisciplinary programs combine medicine, physical therapy, psychology, and vocational support with shared goals and regular communication.
Psychological treatment
Psychological treatments are active, skills-based therapies, not mere reassurance. CBT targets catastrophic thinking and maladaptive beliefs; ACT builds acceptance and values-based action; graded exposure treats fear-avoidance; operant approaches reinforce well behavior; relaxation and biofeedback reduce arousal. Motivational interviewing improves engagement.
Rehabilitation emphasizes function over pain intensity: graded activity, aerobic exercise, strength and flexibility, pacing, sleep hygiene, and return-to-work planning. Multidisciplinary care is not the same as interdisciplinary care; the latter is a coordinated team with a shared plan.
Professional and regulatory duties
Duties include informed consent, shared decision making, documentation, controlled-substance agreements, prescription drug monitoring program checks, urine drug testing, and compliance with DEA schedules and telehealth rules. Schedule II drugs generally cannot be refilled; partial fills and emergency oral prescriptions have narrow exceptions. Know your state and federal obligations.
Trap: psychological therapy is not evidence that the pain is unreal. Another trap: one physician plus a psychologist is not an interdisciplinary program.
Rule of thumb: measure function, mood, and risk, not just pain scores.