An Effective Patient-Centered Approach to Chronic Pain: A Case Report

Abstract

Background: Chronic pain is a highly prevalent chronic condition in Canadians, which is arduous to treat and leads to a multitude of chronic comorbidities if treated sub-optimally. We aim to provide an example of evidence-based inter-disciplinary care in a community-based clinic for a 28-year old female with 9-year history of chronic neck and back pain whose symptoms were not controlled by multiple prior treatment modalities.

Case: The patient developed constant neck pain and back pain with debilitating headaches and mood disorder after a motor vehicle accident. Subsequent therapy included a wide variety of medical interventions, manual therapies, and counselling, while using emergency room visits for managing pain flare-ups. The patient underwent myofascial trigger point injections targeting previously identified myofascial pain, then diagnostic ultrasound-guided medial branch blocks to assess facet joint involvement, followed by prolotherapy while awaiting referral to radiofrequency ablation of affected sites. Simultaneously, she joined in-clinic group education programs aimed at self-management of headaches and sleep, psychological response to pain, counselling for behaviour modification, diet planning, and functional movement rehabilitation by multiple health practitioners.

Results: The patient noted progressive improvement within12 months after her initial visit  with substantial improvements in pain severity and interference, ability and confidence in coping with pain, and depressive symptoms.

Conclusions: This case report documents a successfully managed case of chronic neck and back pain by augmenting the ongoing procedures with patient education and behavioural change programs which address other crucial components of pain control such as sleep, nutrition, and retraining movement.