Multimodal Pain Therapy

Many patients with chronic pain go through a long journey of therapies, from manual therapy to fango, from acupuncture to massages, injections and much more. However, these therapies, which are often very effective for acute pain, are of little help for chronic pain. In contrast to acute pain, which lasts for a maximum of 12 weeks, the usual one-sided therapies often no longer help.

In chronic pain, psychological and social factors play a major role in addition to the physical causes of the pain. Chronic pain is caused by a complex interplay of bio-psycho-social factors (see also article “How does back pain become chronic?”“]. Therefore, in contrast to one-sided unimodal therapies, an interdisciplinary, multimodal therapy is necessary which also takes bio-psycho-social stress factors into account. [1]

What is multimodal pain therapy?

Multimodal pain therapy is the holistically oriented, comprehensive treatment of people with chronic pain diseases. At least three professional groups are involved in the treatment of the patient: Doctors, psychologists and movement therapists, often also occupational therapists accompany the treatment. Close interdisciplinary cooperation is a basic prerequisite for multimodal pain therapy in order to ensure optimum patient care. The treatment team works hand in hand and there is a regular exchange in team meetings.

A fundamental goal of multimodal pain therapy is to restore the ability to function in everyday life and to develop one’s own competencies and strategies in dealing with the pain disorder. This goal can look different for each patient, therefore the individual therapy goals are determined together with the patient at the beginning of the therapy. The patient is at the centre of the entire therapy. An attempt is made to meet the individual needs of the patient. [2]

For which diseases is multimodal pain therapy suitable?

Multimodal pain therapy is recommended primarily for patients with chronic pain syndromes, including all chronic pain disorders such as chronic back pain, migraine headache and fibromyalgia. However, the therapy is also recommended for patients with an increased risk of chronification with the aim of preventing the pain from becoming chronic. In these patients, the interaction of various bio-psycho-social factors increases the probability that acute pain can become chronic. An increased risk of chronic pain can be caused, for example, by stress in the workplace, loss of quality of life or depressive mood, anxiety or worries. [2,3]

What does the therapy program look like?

The therapy program of multimodal pain therapy includes medical units, movement therapy and psychological units. The therapy modules are closely interlinked, build on each other and thus enable very intensive treatment. Treatment usually takes place in small groups.

An important part of the medical therapy modules are information events in which knowledge about the origin of pain, pain perception, specific disease patterns and pain medication is imparted. Therapy is accompanied by one-on-one medical consultations, where the medication is discussed, follow-up examinations are carried out and there is room for the patient’s personal medical concerns.

The psychological therapy modules also consist of information events in which knowledge about pain experience, the interaction of bio-psycho-social factors, dealing with stress or other everyday stresses and pain management is imparted. In the group, psychological pain management strategies are practiced, for example relaxation techniques such as progressive muscle relaxation according to Jacobson or autogenic training. Therapy is accompanied by individual psychological discussions with room for personal topics and concerns.

The movement-based therapy modules serve to activate and restore physical function and performance. In the units, body perception is improved, physical strength, endurance, mobility and coordination are trained with various exercises. This starts with very easy movement exercises, which are increased step by step. On the one hand movement therapy calls for activity, on the other hand theoretical knowledge about training organization and rest in everyday life is taught.

In many pain therapy facilities, in addition to these three therapeutic modules, there is a supplementary offer with ergotherapy, music or art therapy.

The therapy program usually takes place daily spanning over a period of four to five weeks. In some institutions there are already part-time groups that take place 2 to 3 days a week. [2,4]

What success can I expect from multimodal pain therapy?

Multimodal pain therapy has so far proven successful in the treatment of chronic pain diseases. Some studies have already scientifically investigated the results that can be achieved by the therapy. The treatment results were consistently very good and stable. The pain symptoms were significantly reduced by a multimodal therapy program lasting several weeks. Immediately after the therapy and after 6 months, patients reported significantly reduced pain.

The physical performance improves steadily and therefore there are fewer restrictions in everyday life after the end of the therapy. Patients continue to visit a doctor much less often after the therapy. 60 to 70 percent of patients are able to return to work directly after the multimodal pain therapy and can work normally in their profession, which is significantly more than with conventional unimodal pain therapies. Studies also show that the mood of patients improves significantly and that there are fewer depressive symptoms after the end of therapy. Overall, the general quality of life is significantly improved by multimodal pain therapy. [5,6]

Why haven’t I heard of multimodal pain therapy yet?

The multimodal program was only established in Germany in the 1990s . Since then, the concept has spread and found approval in many pain therapy institutions. So far, however, there are comparatively few pain therapy institutions in Germany that offer an intensive multimodal programme. In Germany, the availability of multimodal pain therapy is still far from being sufficient or widespread. In some German states there are still no offers for multimodal pain therapy. The German Pain Society continues to demand the expansion of pain therapy centres with a multimodal range of therapies. [1,7,8]

Helping people to help themselves

Multimodal pain therapy offers a wide range of strategies and exercises that help to deal with chronic pain. In the long term, positive therapy results such as pain reduction and improved performance can be observed. Multimodal pain therapy is based on the motto “Helping patients to help themselves” and aims to ensure that patients themselves know how to deal actively and independently with the pain. The goal is that the patient has his own individual strategies at the end of the therapy with which he can relieve his pain independently. Due to the very good treatment results, multimodal pain therapy is recommended in the national guidelines as the optimal therapy for chronic pain. [9]

If you are interested in multimodal pain therapy, check out the Kaia-Health App. The app enables the therapy to everyone. With less than 15 minutes of Kaia exercising a day, you strengthen and stabilize your back in the long run and you will be on the best path to a pain-free life. It contains 150 back exercises, which were created in cooperation with the pain specialists of a large pain centre and uses them to create an individual training plan.