Pain Medicine

Bridging the Gap

Multidisciplinary Pain Management

BY Larry Studt, Md

Cases like this are unfortunately all too common; more than 50 million adults in the U.S. live with chronic pain, yet it remains one of the most difficult conditions in medicine to treat. Far too many suffer for years while searching for answers, frustrated, discouraged and uncertain whether meaningful improvement is possible at all. Today's chronic pain patients are increasingly complex from a medical standpoint; many are managing multiple chronic conditions simultaneously. Arthritis, diabetes, obesity, cardiovascular disease, sleep disorders, depression, anxiety or the long-term effects of previous injuries and surgeries are all common among chronic pain patients, and these conditions often interact with one another, making it difficult to address a single source of pain. They may have already seen multiple physicians, undergone surgery, completed physical therapy, tried numerous medications or pursued alternative medicine.

More than 50 million adults in the U.S. live with chronic pain.

In the hypothetical case above, her lower back pain compounded into reduced mobility, loss of physical conditioning, disrupted sleep, social isolation, depression and diminished quality of life. The pain affects not only the body but also the patient's confidence, independence and ability to engage in meaningful activities. These realities make it increasingly difficult to separate the physical, psychological and social dimensions of pain, and they are a primary reason multidisciplinary pain management is so important. During my years with Nura Precision Pain Management, a pain clinic that specializes in multidisciplinary care, I have witnessed significant changes in both the patients we treat and the therapies available to help them.

As health care has grown more specialized, chronic pain patients have become more challenging to treat. Specialization has driven real advances, but it also leaves gaps for patients whose pain doesn't fit neatly into one specialty: a surgeon may fix a structural issue but can't resolve anxiety or sleep disturbances; a physical therapist may restore mobility but can't manage medications; a psychologist may address coping but can't perform a procedure.

Chronic pain sits at the intersection of physical, psychological, behavioral and social factors. Therefore, a coordinated team approach is so much more effective than a series of disconnected referrals. Multidisciplinary pain management breaks the siloed structure of specialized medicine and closes that gap in coordinated care for patients — anesthesiologists, neurologists, physiatrists, physical therapists, psychologists, occupational therapists and nutritionists — each specialty supports the others. Interventional procedures can create enough relief for rehabilitation to work, physical therapy rebuilds strength and function, behavioral health addresses the sleep, stress and coping challenges that accompany chronic pain and medication becomes one part of the plan rather than the whole plan. The goal of a multidisciplinary, holistic approach isn't simply less pain, but more function, independence and better quality of life.

Along with changes in the complexity of treating chronic pain patients, reimbursement models have also transformed considerably in the past few decades. This is the reason most often cited for the closure of multidisciplinary pain clinics. The underlying economics are straightforward: standard insurance reimbursement models heavily favor high-volume, interventional procedures while chronically underfunding the time-intensive cognitive, physical and behavioral therapies that form the bedrock of complex pain management. The result is a system in which comprehensive pain management may be clinically advantageous but operationally difficult to sustain. This structural shift has created a significant gap between clinical ideals and real-world patient access. According to national data from the U.S. Pain Foundation, a striking 76.5% of chronic pain patients who managed to secure care at a dedicated pain center reported that the facility offered access only to a physician, completely lacking integrated behavioral or rehabilitative specialists.

When clinic networks face these financial strains, the consolidation can be highly disruptive. Financial restructuring and sudden closures of larger regional pain groups have occasionally left tens of thousands of complex patients looking for new providers all at once. As the medical community adapts to these economic realities, the challenge moving forward will be advocating for reimbursement models that value collaborative, holistic healing over isolated interventions, ensuring patients receive the comprehensive care they actually need.

The change for a patient can be a big shock. In the Twin Cities, as clinics have closed or restructured, many patients have found themselves unexpectedly searching for new providers and new care teams after years — sometimes decades — of receiving care from the same practice.

Care Coordination

Coordination is easier described than delivered. Without a multidisciplinary model, patients seeking holistic treatment on their own are at an extreme disadvantage; most have little understanding about what therapies are available, how to engage multiple providers, or even how to manage referrals, scheduling and insurance. Of course, chronic pain patients must still manage their pain day-to-day, as best they can. Insurance alone can be its own maze for individuals: coverage rules, prior authorizations and network requirements often differ by discipline, so a patient may need separate approvals for physical therapy, behavioral health and interventional procedures — each with its own visit limits, copays and paperwork. Trying to manage their care alone, even a motivated patient can lose momentum just trying to keep the paperwork straight, and the multi-modal approach quickly narrows down to whatever is easiest to schedule and find coverage for. Providers face the same problem in reverse: without a shared structure, each specialist may see only their piece of the puzzle and may find their reimbursement denied or reduced. A multidisciplinary model such as the one Nura has used since 1995 creates one point of contact for the patient, one shared plan for the clinicians and knowledgeable administrative support to ensure alignment with insurance providers.

Chronic pain sits at the intersection of physical, psychological, behavioral and social factors.

It's worth noting that not every behavioral health provider is equipped to provide pain-specific care. Training in approaches developed specifically for pain, such as cognitive behavioral therapy for chronic pain or acceptance and commitment therapy, is paramount, as is experience working as part of a coordinated pain management team rather than in isolation. Patients and referring physicians alike should feel comfortable asking a prospective behavioral health provider directly about their experience treating chronic pain, rather than assuming any licensed therapist can fill this role.

The Patient Perspective

One lesson learned over the years is that patients rarely arrive seeking multidisciplinary care. They come looking for relief. They often believe the answer lies in a medication adjustment or a procedure. Sometimes that is part of the solution. More often, however, meaningful improvement occurs when multiple factors are addressed together. One of the responsibilities of pain specialists is helping patients understand how medicine, movement, behavioral health and lifestyle changes can work together to improve both pain and function.

Of course, one size never fits all. I have seen patients achieve meaningful improvement only after combining medication optimization with physical therapy and behavioral health support. Others have benefited from advanced interventional procedures like an intrathecal pain pump, but their long-term success depended on maintaining physical activity and function afterward. Still others arrived convinced their pain couldn't be touched, only to discover relief in an individualized, coordinated treatment plan. These observations reinforce a simple lesson: chronic pain is rarely solved by a single intervention and the most successful outcomes occur when patients become active participants in their comprehensive and personalized treatment plan.

This is the model Nura has built its practice around: physicians, psychologists, physical therapists and advanced practice providers working together under one roof, rather than referring patients out and hoping the pieces come together on their own. Time and again, we've seen that patients do best when treatment is coordinated across disciplines instead of delivered in isolation, and that conviction is why we've stayed committed to comprehensive, team-based care even as reimbursement pressures have pushed other clinics to scale it back. It is why we continue to be at the vanguard of multidisciplinary pain management.

The future of pain medicine will undoubtedly bring new technologies, new procedures and new treatment options. But it will be just as important to preserve access to coordinated, patient-centered models that let new therapies and tried-and-true treatments reach the people who need them. The evidence supporting multidisciplinary care is substantial: for many patients living with chronic pain, coordinated treatment is the difference between simply managing symptoms and regaining meaningful function, independence and quality of life. As physicians, health care leaders and policymakers weigh the future of pain management, ensuring access should remain a priority. For millions of Americans living with chronic pain, this is not simply a health care issue — it is a quality-of-life issue. For the patient described at the start of this piece, and for the tens of thousands like her, that access can mean the difference between merely managing pain and reclaiming a life.

Larry Studt, MD, is a family medicine and occupational health physician who serves as the medical director of Nura Pain Clinics in Minnesota. With over 30 years of medical experience, he specializes in collaborating across multidisciplinary teams to develop comprehensive, compassionate care plans for patients living with complex chronic pain.