Multimodale Behandlung bei chronischen Schmerzen – Chance und Herausforderung für die Zusammenarbeit von Psychosomatik und Physiotherapie

Abstract

Chronic pain is often associated with inefficient treatments attempts and a significant impairment of quality of life. The treatment of patients with chronic pain has been a major challenge for all disciplines concerned; none has convincingly shown that their approach achieves the goal of a pain free life. Multimodal pain management programs are characterised by a joint effort of somatic medicine, physiotherapy, and psychology or psychotherapy to cooperate in a shared model of diagnosis and treatment for chronic pain patients. We present the model that is in practice since eight years at the Division of Psychosomatic Medicine at the University Hospital Basel, combining elements of cognitive behaviour therapy and physiotherapeutic exercises. The presence of physiotherapists in therapeutic group sessions is essential because physical activation helps to improve body awareness; it yields bodily sensations that are often interpreted in a catastrophic way that can then be dealt with in a cognitive-behavioural approach. Such a close collaboration between different departments and between representatives of different professions takes time to develop, it needs open minded psychologists and physiotherapists who are willing to cooperate and share responsibility. On the other hand, having achieved a good working relationship leads to mutual support in working with these patient who sometimes induce intense feelings of helplessness in the professional, it provides patients with two different 'battlefields' to tackle chronic pain, thus allowing for a broader set of experiences from which patients can feed their motivation.