Introduction
Chronic pain requires a multidisciplinary approach to uncover its root causes and create effective care plans. Research advances in neuroscience, immunology, and physical therapy highlight the importance of integrating physical therapy, rheumatology, psychiatry, and interventional pain medicine. These specialties address pain’s complex mechanisms, offering patients evidence-based solutions and renewed hope.
The Birth of the Chronic Pain Round Table: A Collaborative Journey
The idea for what I now call the Chronic Pain Round Table came to me almost by accident. It wasn’t some grand plan or carefully laid-out strategy; it happened because I worked alongside a team of specialists from vastly different fields, tackling some of the most complex cases of chronic pain. What began as casual conversations and exchanging ideas became an extraordinarily multidisciplinary approach to solving the puzzles of chronic pain.
We weren’t just discussing cases; we were questioning everything. Why is this patient still in pain despite all the treatments? What are we missing? Could it be something inflammatory, psychological, or mechanical? We moved opinions around, dissected our assumptions, and challenged one another. These moments made it clear that no single specialty had all the answers. Chronic pain demanded an approach that brought together the unique strengths of Interventional Pain Medicine, Physical Therapy, Rheumatology, and Psychiatry.
Chronic Pain: A Puzzle Needing Many Perspectives
Chronic pain isn’t just “pain.” It’s a complex condition that persists beyond the usual course of healing, disrupting every aspect of life—physical, emotional, and social. Diagnosing is often a maze of nonspecific symptoms, overlapping conditions, and systemic challenges like delayed referrals or biases in healthcare.
As a team, we began to see patterns emerge. A patient with fibromyalgia was misdiagnosed as depressed. A patient post-surgery whose chronic pain was dismissed as psychological. A patient with an autoimmune condition masquerading as a musculoskeletal issue. Each case reminded us how vital it is to look beyond our specialty and piece the puzzle together collaboratively.
How We Built the Round Table
Each specialty brought something crucial to the table, and watching those contributions blend was nothing short of inspiring:
1. Interventional Pain Medicine
These specialists delivered targeted, minimally invasive treatments like nerve blocks and epidural injections. Their ability to pinpoint pain generators often gave patients the relief they needed to engage in physical therapy or other treatments. I remember one case where a patient with debilitating back pain found immediate relief after a carefully placed injection. That relief wasn’t the end goal—it was the beginning of a recovery plan involving the entire team.
2. Physical Therapy
Movement is medicine, but chronic pain often traps people in a cycle of immobility and worsening disability. Physical therapists broke that cycle by designing personalized exercise programs and teaching patients to move without fear. Through their expertise, we saw patients reclaim mobility and independence. They also served as bridges, reinforcing the work of the other specialists by addressing the physical manifestations of systemic or emotional pain.
3. Rheumatology
The rheumatologist’s role was transformative for patients with underlying autoimmune or inflammatory conditions. By identifying systemic issues like rheumatoid arthritis or lupus, they provided the answers that other treatments had missed. I vividly recall how a single blood test revealing inflammatory markers completely shifted the course of treatment for one patient who had been misdiagnosed for years.
4. Psychiatry
Chronic pain isn’t just physical; it takes a profound psychological toll. The psychiatrists on our team helped patients reframe their pain through therapies like cognitive-behavioral therapy (CBT) and mindfulness. They addressed the anxiety and depression that often accompany chronic pain, breaking the cycle of emotional distress and heightened pain perception.
The Power of Collaboration
One of the most powerful lessons I learned was that chronic pain isn’t just one person’s problem to solve. It’s a shared challenge that demands input from every angle. In one particularly complicated case, a patient with chronic low back pain received a targeted injection from our pain specialist, started a core-strengthening program with the physical therapist, worked with the psychiatrist to manage anxiety, and underwent evaluations by the rheumatologist to rule out inflammatory conditions. Each specialist’s contribution was a piece of the larger puzzle. Together, we gave that patient a roadmap to recovery.
Interconnected Solutions for an Interconnected Problem
Through this experience, I’ve come to see chronic pain as a web of interconnected issues—movement limitations, inflammation, psychological factors—each feeding into the other. Addressing one without the others is like plugging a single hole in a sinking ship. It’s only when we work together that real progress is made.
For example, managing inflammation through medications or interventions allows patients to move more freely, enabling physical therapy to take root. Meanwhile, psychological support helps patients overcome fear-avoidance behaviors, motivating them to stay engaged in treatment. It’s a cycle, but when approached collaboratively, it becomes virtuous.
A New Way Forward
What started as a chance collaboration turned into a structured approach—a round table where every voice is valued and every perspective matters. This approach isn’t about treating pain as an isolated problem; it’s about treating the whole person.
The lessons I’ve learned through this journey have changed the way I approach chronic pain entirely. I’ve seen patients reclaim their lives—not just through one treatment or one specialty, but through the collective effort of a team dedicated to solving the unsolvable.
Summary of Tips on Starting Your Own “Chronic Pain Round Table”:
Start Local
- Reach out to specialists in nearby clinics and hospitals.
- Attend local interdisciplinary meetings to network and recruit.
- Visit practices to introduce your project.
Inpatient Setting
- Collaborate with hospital teams and department heads.
- Hold regular interdisciplinary case rounds for complex cases.
- Focus on unresolved cases from referrals or rounds.
Outpatient Setting
- Partner with local clinics and rehabilitation centers.
- Use telemedicine platforms for remote meetings.
- Schedule regular but flexible sessions.
- Offer incentives like CME credits.
Communication Tools
- Use tools like Google Calendar for scheduling.
- Discuss cases on secure platforms like Zoom.
- Use Slack or WhatsApp for updates.
- Store documents securely on Google Drive.
Key Notes
- Emphasize the benefits of collaboration.
- Stay flexible with schedules and tools.
- Showcase success stories to motivate the team.
The Chronic Pain Round Table emerged from collaborative discussions, uniting specialties to tackle chronic pain holistically. This approach addressed physical, inflammatory, and psychological factors, empowering patients to reclaim their lives.
References
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6. Connell N, Lorenz KA, Wong CC, et al. Teaming in interdisciplinary chronic pain management in primary care. J Gen Intern Med. 2022;37:1501-1512. doi:10.1007/s11606-021-07255-w
7. Franqueiro AR, Curiel M, Wilson JM. The interconnection between social support and emotional distress among individuals with chronic pain. Psychol Res Behav Manag. 2023;16:4389-4399. doi:10.2147/PRBM.S410606
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Key Words: multidisciplinary team, neuroinflammatory component, patient empowerment
Author declares no conflicts of interest.
Author information:
Dr. Islam Hewidy, PT, DPT, OCS is an Adjunct Assistant Professor of Physical Therapy and Pain Science at New York Medical College and Hofstra University. He is renowned for his musculoskeletal dysfunction and pain science expertise with a Doctor of Physical Therapy from Dominican University of New York and American Board Certification as an Orthopaedic Clinical Specialist. Dr. Hewidy is a member of the Specialization Academy of Content Experts (SACE) for the American Board of Physical Therapy Specialties and contributes to the Academy of Orthopedic Physical Therapy Education Committee. As the founder of the Chronic Pain Rehabilitation Center in New York City and author of Chronic Pain Round Table, he integrates research, clinical innovation, and multidisciplinary approaches to advance chronic pain management.