DOCC-A Framework of Care

The DOCC program is a framework that breaks down the pain experience into its various component parts. This framework enables the providers and patients to communicate much more clearly, and effectively so as to develop a partnership to solve the problem. With musculoskeletal pain, there are three components to the problem:

• Possible anatomic structural problems that need definition
• The soft tissues such as ligaments, discs, fascia, etc.
• The central nervous system

The first step that must occur is for your physician and you to have a clear idea whether there is possible structural problem and can and should be surgically addressed. If there is a correctable problem then you need to decide whether you pain is severe enough to undergo surgical intervention. If it is then get it done. If the pain is not severe enough to warrant the risk of surgery or the problem is not structural then you can fully engage in the rest of the DOCC protocol. If the pain is chronic and/or your frustration levels are elevated, it is necessary to first calm down the central nervous system before the soft tissues can be adequately addressed. Otherwise, when painful soft tissues are aggressively manipulated there will be an exaggerated pain response. The DOCC program is organized around the following six variables:

• Sleep
• Stress management
• Medications
• Goal setting/vocational issues
• Education
• Rehabilitation

You might notice that the first five of the categories either directly or indirectly affect the central nervous system. Improving sleep will decrease the perception of pain and improve your sense of well-being. Stress is an obvious issue regarding the central nervous system. Everyone has stress. Most of us have a lot of stress and have never adequately been taught stress-management skills. The additional stress of chronic pain is a major problem. Medications are used to decrease the pain on a short-term basis to help improve function. Education and goal setting will decrease your anxiety and frustration. Rehabilitation of the soft tissues is the definitive final step. It must be done well and maintained on an indefinite basis. What exactly is done within each category is not as important as having ALL of the categories successfully defined and treated. You will already have been through many of the treatments that will be described. However, I feel it is the structured combination of these variables, which will make an impact on your pain and quality of life.