A prospective one-year outcome study of interdisciplinary chronic pain management: compromising its efficacy by managed care policies.
Although interdisciplinary pain management programs are both therapeutically effective as well as cost-effective, they are currently being underutilized because of managed care policies. We used this prospective comparison trial, with 1-yr follow-up of chronic pain patients, to demonstrate the short- and long-term efficacy of an interdisciplinary pain management program, and evaluate the impact of managed care's physical therapy "carve out" practices on these treatment outcomes. Consecutive chronic pain patients (n = 201) were evaluated, some of whom had their physical therapy "carved out" from this integrated program. Results revealed that successful completion of interdisciplinary pain management was therapeutically effective. Most importantly, physical therapy "carved out" practices had a negative impact on both the short-term and 1-yr follow-up outcome measures. Thus, interdisciplinary pain management is effective in treating the major health problem of chronic pain. However, insurance carrier policies of contracting treatment "carve outs" significantly compromise the efficacy of this evidence-based, best standard of medical care treatment. This raises important medico-legal and ethical issues.


CONCLUSIONS
Interdisciplinary pain management is effective and cost-effective in treating the major health problem of chronic pain. The present study demonstrated its efficacy using a prospective, 1-yr posttreatment evaluation methodology. Moreover, physical therapy "carve out" practices by insurance carriers had a negative impact on the outcomes, raising important medico-legal and ethical issues.
Robbins
Heather
H
The Eugene McDermott Center for Pain Management, The University of Texas Southwestern Medical Center at Dallas, 75390, USA.
Gatchel
Robert J
RJ
Noe
Carl
C
Gajraj
Noor
N
Polatin
Peter
P
Deschner
Martin
M
Vakharia
Akshay
A
Adams
Laura
L
D002908:Chronic Disease; D003863:Depression / Q000523:psychology; D004185:Disability Evaluation; D005500:Follow-Up Studies; D006801:Humans; D008329:Managed Care Programs / Q000458:organization & administration*; D010146:Pain / Q000523:psychology; D059408:Pain Management; D010147:Pain Measurement; D010352:Patient Dropouts / Q000706:statistics & numerical data; D026741:Physical Therapy Modalities; D011446:Prospective Studies; D011569:Psychiatric Status Rating Scales; D011795:Surveys and Questionnaires; D016896:Treatment Outcome