After careful assessment and development of a treatment plan, identified pain patients should be engaged into a multimodal, multidisciplinary treatment paradigm. Historically, the origin of the multidisciplinary approach in the treatment of pain is the legacy of John Bonica, MD, an anesthesiologist and one of the pioneers of pain medicine. Today, the multidisciplinary approach prevails. In fact, use of an independent multidisciplinary assessment for treatment planning, including extensive intake evaluation by a team of therapists, counselors, and a physician, with subsequent generation of a comprehensive report, has been studied and found to provide a potentially reproducible standard for both research and clinical use [2].

Multidisciplinary care includes a continuum of medication management, rehabilitation (physical, occupational, vocational), interventional treatments, psychological co-management, complementary and alternative options, and of course surgical management of pain. After appropriate triage, evaluation, and assessment, placement of the identified pain patient into the appropriate treatment algorithm is guided by a number of tools, as well as their previous treatment history within the multidisciplinary approach.

Clinical practice guidelines are another essential tool to guide treatment of the identified pain patient. These guidelines present statements of best practice, which are based upon careful and exhaustive assessment of the available evidence from published studies on the outcomes of different treatment options. In November 1989, Congress mandated the creation of the Agency for Healthcare Policy and Research (AHCPR) . This organization was given broad responsibility to support research, data development, and related activities. In conjunction with this mandate, the National Academy of Sciences published a document indicating that guidelines were expected to improve the quality, appropriateness, and effectiveness of health care services.

Of the different societies promulgating guidelines, some are more medical, some more interventional, and others more surgical. Examples of each include the American Pain Society (APS) in conjunction with the American College of Physicians (ACP), the American Society of Interventional Pain Physicians (ASIPP), and the North American Spine Society (NASS), respectively. As various society recommendations reflect upon variable vested interests, education, through the use of shared decision, is essential to navigate the various guidelines. Shared decision making helps the patient to negotiate through the different medical, interventional, and surgical treatment options to make an autonomous and informed decision best individualized to meet his/her personal functional goals.

One specific set of medical guidelines by the APS/ACP stands out among these classification systems, which is summarized in the following bulleted recommendations: