C1 Transforming Pain Management from the Perspective of a Neurobiopsychosocial Pain Practice

Abstract

The purpose of this paper is to reflect on our present-day knowledge about the nature of pain in order to better inform pain assessment and management. Pain has been well defined as a neurobiopsychosocial experience. Evidence supporting this classification has emerged from a multidisciplinary collective, including neuroscience, medicine, nursing, psychology, and a lesser-known component, somatic therapy. Pain, whether acute or chronic, is a phenomenon that elicits an intricate perceptual process and a complex affective response. That pain is an experience of one's entire being is borne out in a continuum of evidence extending from patient narratives to fMRI images. The benefit of integrative strategies to address pain management is well documented, including therapies utilizing exercise and interoception-focused somatic movement, meditation, breath work, psychotherapy, and pharmacology. A numerical rating scale alone has been found to be an inadequate measure of pain and is poorly correlated to patients' satisfaction with overall pain management. And yet, pain assessment continues to primarily reflect a biomedical paradigm, with emphasis on a unidimensional measurement of pain intensity obtained either by numerical or image-based tools. Assessment based on components such as patient narrative tends to be devalued. As a result, pain management continues to primarily reflect a pharmacology-centric model in which multidisciplinary strategies able to modulate the pain experience occur only as alternative and secondary interventions rather than as equally indispensable components that support a well integrated pain management plan of care based on patients' unique attributes and histories. Reconfiguring pain assessment to better match patient characteristics with treatment modalities will require a cultural transformation inclusive of clinician education, methods of pain assessment and skills for effective patient engagement. This paper thus queries the cultural shift necessary to transform the traditional model of pain management into a practice that reflects present-day neurobiopsychosocial knowledge.