Rational integration of pharmacologic, behavioral, and rehabilitation strategies in the treatment of chronic pain.

Historically, the concept of a mind-body duality in medicine, which supports a biomedical approach to pain management, has impeded the development of adequate treatments for persistent pain conditions and diseases. Although usually there is an initiating pathophysiologic nociceptive cause of pain, over time, the conditioning of neurophysiologic and affective systems by environmental and internal events can promote chronicity and frustrate the efforts of physicians to attenuate nociceptive processes. A full elucidation of the environmental and psychological factors contributing to pain and suffering may prove difficult using a traditional biomedical approach. Prevention of chronicity, by early identification and treatment of pain generators and the pain response to tissue injury and by recognition of those general factors that contribute to risk for chronicity (e.g., depressive illness, poor pain control), is crucial for any healthcare system that wishes to reduce the morbidity and costs of persistent pain. Goal-directed, outcomes-focused biopsychosocial treatment plans that efficiently integrate physical, behavioral, and medical approaches more frequently achieve better pain control and improved function. The following article presents a general overview of evidence for effectiveness of these approaches and some central principles of integrated treatment planning.