1. 2021;24;369-378Utilizing Multidisciplinary Medicine in Pain Management: A Narrative Review
   Narrative Review
   Heather A. Flynn, PhD, Phillip R. Worts, PhD, Gilbert Chandler III, MD, and Alexis M. Rojas, MSW.

BACKGROUND: The role of psychological factors influencing chronic pain has been well documented. This review includes a historical perspective and current examination of the literature on psychological and behavioral health characteristics and their influence on chronic pain.

OBJECTIVES: To identify psychological and behavioral health factors involved with chronic pain, as well as the challenges and opportunities of integrating multidisciplinary care into a pain management practice.

STUDY DESIGN: Narrative review of peer-reviewed literature examining psychological and behavioral health factors associated with poor clinical outcomes with an emphasis on orthopedics.

METHODS: The Medline database was reviewed to identify peer-reviewed research that discussed psychological and behavioral health factors relevant to pain management or orthopedics.

RESULTS: The evidence provided suggests that these constructs should receive strong consideration when managing chronic pain. The incorporation of such factors may improve patient care and clinical outcomes and reduce total health care costs.

LIMITATIONS: This narrative review is not systematic in nature, but rather focused on the impacts on orthopedics and pain management.

CONCLUSIONS: Psychological and behavioral health factors should be an integral component of a pain management practice as there is substantial overlap between depression and anxiety with chronic pain. Positive affect, such as resilience, may act as a buffer and confer some protection against the sequelae of chronic pain. There is evidence that psychological screeners offer further insight into the patient condition and would contribute to the treatment plan. The novel role of a behavioral health navigator in a pain management clinic is worthy of further exploration as it has proved beneficial in other chronic health conditions.

KEY WORDS: Pain management, chronic pain, psychological, multidisciplinary, behavioral health navigator, resiliency, opioids