Effectiveness of chronic pain rehabilitation programs

It often comes as a surprise to patients that chronic pain rehabilitation programs are typically the most effective form of treatment for patients with chronic (non-cancer) pain syndromes. As a society, we tend to assume that medications, procedures and surgeries are not only effective, but are the most effective treatments for chronic pain. But, it’s not the case.

Criteria for Effectiveness

In the field of chronic pain management, we tend to use certain criteria by which to measure the effectiveness of treatments. These criteria are the following:

  • Pain reduction
  • Improvement in functioning (such as, return to work rate)
  • Reduction in the need for opioid, or narcotic, pain medications
  • Reduction in the use of healthcare services for pain, more generally

These standard criteria make sense. A treatment is judged effective to the extent that it reduces pain, helps people return to work, helps them to need less narcotic pain medications, and helps patients to not have to see their healthcare providers as much.

chronic pain rehabilitation program

Pool therapy in a chronic pain rehabilitation program.

Let’s review each of these criteria one at a time, comparing how chronic pain rehabilitation programs do with other standard medical care (which might include narcotic and non-narcotic pain medications, procedures and surgeries) for chronic pain.

Pain Reduction

  • 20-40% average reduction in pain following participation in chronic pain rehabilitation programs (Gatchel & Okifuji, 2006; Turk, 2002)
  • 30% average reduction in pain with standard medical care (Gatchel & Okifuji, 2006)

Return to Work Rates

  • 60% rate of return to work following participation in chronic pain rehabilitation programs (Flor, Frydrich, Turk, 1992; Gatchel & Okifuji, 2006)
  • 27% rate of return to work with standard medical care (Gatchel & Okifuji, 2006)

Reductions in Opioid, or Narcotic, Pain Medication Use

  • More than 60% of patients are able to taper from opioid pain medication use following participation in chronic pain rehabilitations (Tollison, Kriegel, & Downie, 1985; Tollison, Hinnant, & Kriegel, 1991; Turk, 2002)
  • Less than 10% of patients are able to taper from opioid pain medications with standard medical care (Tollison, Kriegel, & Downie, 1985; Tollison, Hinnant, & Kriegel, 1991)

Reductions in Healthcare Utilization

  • 68% reduction in overall medical costs following participation in chronic pain rehabilitation programs (Gatchel & Okifuji, 2006)
  • Generally not reported in efficacy studies of medication management, interventional procedures, or surgeries, though 15-20% of those receiving spinal surgery will require re-operation (Gatchel & Okifuji, 2006; Turk, 2002)

Chronic pain rehabilitation programs are powerful interventions. They have significantly higher rates of return to work, significantly greater reductions in opioid, or narcotic, medications use, and significantly greater reductions in the need to seek on-going healthcare for chronic pain.  The comparable statistics between such programs and standard medical care for the criteria of pain reduction is remarkable when considering that over half of patients in chronic pain rehabilitation programs are also tapering opioid, or narcotic, medications.

In all, such outcomes are what make most experts in chronic pain management conclude that chronic pain rehabilitation programs are the most effective treatment approach for patients with chronic pain syndromes.

References

Flor, H., Frydrich, T., Turk, D. C. (1992). Efficacy of multidisciplinary pain treatment centers: A meta-analysis. Pain, 49, 221-230.

Gatchel, R., J., & Okifuji, A. (2006). Evidence-based scientific data documenting the treatment and cost-effectiveness of comprehensive pain programs for chronic non-malignant pain. Journal of Pain, 7, 779-793.

Tollison, C. D., Hinnant, D. W., & Kriegel, M. L. (Eds.). (1991). Psychological concepts in pain. Philadelphia, PA: Lea & Febiger.

Tollison, C. D., Kriegel, M. L., & Downie, G. W. (1985). Chronic low back pain: Results of treatment at the pain therapy center. Southern Medical Journal, 78, 1291-1295.

Turk, D. C. (2002). Clinical effectiveness and cost-effectiveness of treatments for patients with chronic pain. The Clinical Journal of Pain, 18, 355-365.

Author: Murray J. McAllister, PsyD

Date of last modification: 12/6/2012

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