OJO  Vol.5 No.5 , May 2015
Strategies for Managing Chronic Pain: Case of a Skilled Orthopaedic Physician and Mini-Review
Abstract: Epidemiological surveys have recently revealed a high prevalence of chronic musculoskeletal pain in Japan; however, 30% of the patients in the survey were not satisfied with their pain treatment. This indicates that standard strategies in the management of chronic pain are poorly shared among physicians in Japan. Herein we report a case of a patient with intractable chronic pain who is a skilled orthopaedic physician. A 43-year-old man who was a skilled orthopaedic surgeon presented at our center complaining of severe buttock pain especially around the right hip region for more than three years. At begging of pain onset, he was diagnosed with femoacetabular impingement syndrome (FAI) with labral tear. Despite biophysical interventions including twice surgeries and alternative conservative treatment, his pain persisted, and he occasionally had to take a day off work due to the severe pain. Therefore we had to evaluate his pathological condition using a multidimensional approach based on a biopsychosocial model. We had provided him with cognitive behavioral therapy (CBT) approach, and simultaneously suggestion for short leaving from work. Three months after the start of CBT training, his disabilities had begun to improve. About six months later, he could continue to do his work. Finally, 19 months have passed since we started implementing the CBT approach; he has regained both his previous work-life balance and his health, although the pain has not completely subsided. In conclusion, we think it is important for physicians treating chronic pain to learn the management strategies for chronic pain and to re-consider their management policy when conventional biomedical interventions were not succeeded, even in cases where medication and surgical intervention are warranted.
Cite this paper: Ikemoto, T. , Arai, Y. , Nishihara, M. and Ushida, T. (2015) Strategies for Managing Chronic Pain: Case of a Skilled Orthopaedic Physician and Mini-Review. Open Journal of Orthopedics, 5, 109-114. doi: 10.4236/ojo.2015.55014.

[1]   Nakamura, M., Nishiwaki, Y., Ushida, T. and Toyama, Y. (2011) Prevalence and Characteristics of Chronic Musculo-skeletal Pain in Japan. Journal of Orthopaedic Science, 16, 424-432.

[2]   Nakamura, M., Nishiwaki, Y., Ushida, T. and Toyama, Y. (2014) Prevalence and Characteristics of Chronic Musculoskeletal Pain in Japan: A Second Survey of People with or without Chronic Pain. Journal of Orthopaedic Science, 19, 339-350.

[3]   Nakamura, M., Nishiwaki, Y., Sumitani, M., Ushida, T., Yamashita, T., Konno, S., Taguchi, T. and Toyama, Y. (2014) Investigation of Chronic Musculoskeletal Pain (Third Report): With Special Reference to the Importance of Neuropathic Pain and Psychogenic Pain. Journal of Orthopaedic Science, 19, 667-675.

[4]   Ito, K., Minka 2nd, M.A., Leunig, M., Werlen, S. and Ganz, R. (2001) Femoroacetabular Impingement and the Cam-Effect. A MRI-Based Quantitative Anatomical Study of the Femoral Head-Neck Offset. Journal of Bone & Joint Surgery British Volume, 83, 171-176.

[5]   Bedi, A. and Kelly, B.T. (2013) Femoroacetabular Impingement. Journal of Bone & Joint Surgery American Volume, 95, 82-92.

[6]   Finnerup, N.B., Otto, M., McQuay, H.J., Jensen, T.S. and Sindrup, S.H. (2005) Algorithm for Neuropathic Pain Treatment: An Evidence Based Proposal. Pain, 118, 289-305.

[7]   Kikuchi, S. (2008) New Concept for Backache: Biopsychosocial Pain Syndrome. European Spine Journal, 17, 421-427.

[8]   Arimura, T., Komiyama, H. and Hosoi, M. (1997) Pain Disability Assessment Scale: A Simplified Scale for Clinical Use. Japanese Journal of Behavior Therapy, 23, 7-15. (In Japanease)

[9]   Yamashiro, K., Arimura, T., Iwaki, R., Jensen, M.P., Kubo, C. and Hosoi, M. (2011) A Multidimensional Measure of Pain Interference: Reliability and Validity of the Pain Disability Assessment Scale. Clinical Journal of Pain, 27, 338-343.

[10]   Kitamura, T. (1993) The Hospital Anxiety and Depression Scale. Archives of Psychiatric Diagnostics and Clinical Evaluation, 4, 371-372. (In Japanese)

[11]   Zigmond, A.S. and Snaith, R.P. (1983) The Hospital Anxiety And Depression Scale. Acta Psychiatrica Scandinavica, 67, 361-370.

[12]   Matsuoka, H. and Sakano, Y. (2007) Assessment of Cognitive Aspect of Pain: Development, Reliability, and Validation of Japanese Version of Pain Catastrophizing Scale. Japanese Journal of Psychosomatic Medicine, 47, 95-102. (In Japanese)

[13]   Sullivan, M.J.L. and Bishop, S.R. (1995) The Pain Catastrophizing Scale. Development and Validation. Psychological Assessment, 7, 524-532.

[14]   Japanese EuroQol Translation Team (1997) The Development of the Japanese EuroQol Instrument. Iryo to Shakai, 8, 109-123. (In Japanese)

[15]   Dolan, P. (1997) Modeling Valuations for EuroQol Health States. Medical Care, 35, 1095-1108.

[16]   Jamison, R.N. and Edwards, R.R. (2012) Integrating Pain Management in Clinical Practice. Journal of Clinical Psychology in Medical Settings, 19, 49-64.

[17]   Fishman, S.M., Ballantyne, J.C. and Rathmell, J.P. (2009) Bonica’s Management of Pain. 4th Edition, Lippincott Williams & Wilkins, Philadelphia.

[18]   Kamper, S.J., Apeldoorn, A.T., Chiarotto, A., Smeets, R.J., Ostelo, R.W., Guzman, J. and van Tulder, M.W. (2015) Multidisciplinary Biopsychosocial Rehabilitation for Chronic Low Back Pain: Cochrane Systematic Review and Meta-Analysis. British Medical Journal, 350, h444.

[19]   Inoue, M., Inoue, S., Ikemoto, T., Arai, Y.C., Nakata, M., Miyazaki, A., Nishihara, M., Kawai, T., Hatakeyama, N., Yamaguchi, S., Shimo, K., Miyagawa, H., Hasegawa, T., Sakurai, H., Hasegawa, Y., Omichi, Y. and Ushida, T. (2014) The Efficacy of a Multidisciplinary Group Program for Patients with Refractory Chronic Pain. Pain Research & Management, 19, 302-308.

[20]   Lane, R.D. (2014) Is It Possible to Bridge the Biopsychosocial and Biomedical Models? BioPsychoSocial Medicine, 8, 3.