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The Evidence for Multimodal Therapy
What is the evidence to support multimodal treatment of pain?
Dr. Chou: For functionally disabling chronic pain, interdisciplinary rehabilitation -- a type of multimodal treatment that typically incorporates supervised physical therapy and psychological therapies (eg, cognitive-behavioral therapy) as well as other modalities in an integrated fashion -- has been shown in randomized trials to be more effective than single-modality therapies for chronic pain. For low back pain, interdisciplinary rehabilitation has been shown to be as effective as fusion surgery for patients with nonradicular low back pain.
At the same time, there isn't great evidence that piling on lots of interventions is a more effective or efficient strategy in most patients than using one or a few interventions, particularly in patients with acute pain. Patients more likely to benefit from multimodal therapies are those who have chronic disabling pain that has not responded to single intervention, and those who have risk factors for developing chronic disabling pain.
Dr. Argoff: Unfortunately, given all that is recommended about the multimodal treatment of pain, there is little in the way of large prospective studies regarding such an approach to report. On the other hand, there are many studies to support the observation that a single intervention for chronic pain infrequently results in complete pain relief or even significant pain relief for most of the patients exposed to that intervention.
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