Refractory chronic pain

The health care system has been unsuccessful when a patient experiences refractory chronic pain. This patient generates frustration and pessimism for the physician who attempts to provide any future care. The physician's interest and optimism can be restored and sustained by utilizing a systematic interdisciplinary approach utilizing the four perspectives of Life Stories, Dimensions, Behaviors, and Diseases to evaluate the patient in distress with refractory and disabling pain. The design of a comprehensive treatment plan involves the determination of each perspective's contribution to the patient's suffering. The process of formulation recognizes that the perspectives are distinct from one another but complementary in illuminating the various reasons for a patient's suffering. The perspectives offer a recipe for designing a rational treatment plan, rather than just providing a list of ingredients such as biological, psychological, or social, or trying to reduce the individual patient's complexity into a one-dimensional construct. This approach increases the probability of a successful outcome for patient and physician.