Re-Organization of Pain Care: Neuroplasticity to Health System Plasticity

Abstract

At a time when pain management in many countries faces extraordinary challenges in channeling our intellectual resources into policies that actually result in better clinical outcomes, this edition of Pain Medicine brings a hopeful message about health system plasticity in the service of patient rehabilitation. The concept of plasticity is as important to the process of health care re-organization as it is to our understanding of the neurobiology of pain. We know that the brain responds structurally and functionally to environmental conditions and exposures such that neural networks and their dysfunction can be manipulated experimentally and by specific treatment procedures to reverse or modulate the pathophysiologic changes caused by persistent pain signals from the periphery interacting with psychological states. Similarly social systems, as expressions of our collective executive function and sociocultural values and intelligence, can also be manipulated experimentally by carefully constructed strategies that encourage evolution to a more functional state. In this issue of Pain Medicine , Davies, Quintner and colleagues demonstrate how STEPS, a tiered delivery model focused on patient education and self-management, may alter the clinical burden of chronic pain on the health system, reduce wait time for clinical consultation by a specialist, improve patient satisfaction, and reduce costs [1]. In their accompanying Perspective article, they state, “The proposed paradigm shift in service delivery is driven by informed consumers partnered with responsive health professionals” …