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I'm working as an insurance adjuster for a self-insured company. We are trying to determine a coverage policy for patients with chronic pain. So far, after reviewing dozens of cases, there doesn't seem to be any rhyme or reason to the way people are treated. Is there a standard protocol for this problem?

Patients with chronic pain really don't fit in one category together. The only thing they have in common is their pain. Comparing one to another is difficult because they are very different from one another. Some chronic pain patients can be classified into smaller subgroups and treated based on this grouping.

The groups may be defined based on specific characteristics. These may include physical signs and symptoms, physical activity level, or behavioral factors. For example, behavioral factors are known to influence how people deal with their pain.

Fear, fear-avoidance, and anxiety are behavioral factors that can predict and explain disability associated with chronic pain. Pain perception can lead to impaired levels of functioning. Treatment can be geared toward decreasing the impact of these behavioral components. Sometimes the goal isn't to decrease pain but rather, increase activity despite the pain.

One thing that should be standard from patient to patient is the clinical assessment. A complete evaluation of medical, physical, and psychosocial status is important. Finding the right treatment for each person with chronic pain requires an inventory of all possible factors that could affect the patient's disability level.

Experts suggest that treatment must be tailored for each patient based on the results of this assessment. The real goal is to find the right treatment at the right time for each individual. So far, there isn't a cookie cutter approach or recipe that can be applied just because they share a common label.

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