Chronic Pain Rehabilitation

What is a chronic pain rehabilitation program?

Chronic pain rehabilitation programs are a traditional type of chronic pain management. They have long been used to help patients with chronic pain live a normal life. People who most benefit from chronic pain rehabilitation programs are those who have come to accept that their pain is truly chronic and cannot be cured. So, they want to learn what they can do to live a normal life despite having chronic pain.

Chronic pain rehabilitation programs have five goals:

  • Reduce pain
  • Return to work or some other regular, meaningful activity
  • Overcome problems that occur as a result of living with pain, like anxiety, irritability, depression, sleep disturbance, stressed relationships
  • Reduce reliance on the use of narcotic pain medications
  • Reduce reliance on the healthcare system generally

Chronic pain rehabilitation programs focus on what the patient can do to manage pain. While there is often a time and place for relying on care from specialists who perform therapies and procedures, there also comes a time for the patient to take back control and learn how to live a normal life despite chronic pain.

This focus on what the patient can do is called self-management. In general, self-management is a two-pronged approach to managing any kind of chronic health condition. The two prongs are healthy lifestyle changes and increasing the ability to cope with the condition so that the condition itself is no longer a major problem in life. With regard to self-managing chronic pain, the two prongs are:

  • A number of lifestyle changes that reduce pain over time
  • Increasing the ability to cope with the pain that remains

Chronic pain rehabilitation programs are interdisciplinary. Program staff consists of psychologists, physical therapists, physicians, and nurses. Sometimes, such programs may also have occupational therapists and vocational rehabilitation specialists.

Chronic pain rehabilitation programs typically occur on a daily basis over three to four weeks. Someprograms are done on an outpatient basis. Other programs are done on an inpatient basis, with patients going home on the weekends.

A chronic pain rehabilitation program is like a chronic pain school. Patients learn everything they need to know in order to live well despite having chronic pain. The staff are like teachers. In a supportive environment, they coach patients on how to do it.

Chronic pain rehabilitation programs have nine core component therapies:

  • Pool therapy
  • Stretching and core strengthening
  • Mild, low impact aerobic exercises
  • Relaxation therapies
  • Coping skills training
  • Weekly individual psychotherapy
  • Individualized non-narcotic medication management
  • Individualized tapering of narcotic pain medications, as needed
  • Life/work exposure therapy

Most of these components therapies are done in a small group format. All patients in the group have some form of chronic pain.

Because they have been around for a long time, chronic pain rehabilitation programs have a lot of research showing that they are effective.1, 2, 3 On average, patients achieve a 40% reduction in pain by participating in a program. On top of that, most patients taper from narcotic pain medication use. So, they make up for the pain reduction that the pain medications would have produced and still reduce their pain by another 40%.

Additionally, 50% of patients who participate in a chronic pain rehabilitation program go back to work. For sake of comparison, 20-36% of patients go back to work after spine surgery.2, 4 

Because of all this research, many experts agree that chronic pain rehabilitation programs are the most effective treatment for patients with chronic pain.

When hearing about chronic pain rehabilitation programs for the first time, patients often say that they would never be able to do it. They say that they are too disabled to do anything everyday for a number of weeks. However, the typical patient who succeeds in a chronic pain rehabilitation program is a person who has had chronic pain for years. The typical patient has been unable to work for years. In addition, the typical patient is one who struggles to do daily chores and may have difficulty doing even the basics of life, like getting dressed or taking a shower. Emotionally, the typical patient is irritable, anxious and depressed. The typical patient has poor sleep and his or her relationships are quite stressed. As such, chronic pain rehabilitation programs are set up to help the most disabled and distressed people with chronic pain. And they succeed in doing so.

References

1.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.

2. Kamper, S. J., Apeldoorn, A. T., Chiarotto, A., Smeets, R. J., Ostelo, R. W., Guzman, J., & van Tulder, M. W. (2015). Multidisciplinary biopsychosocial rehabilitation for chronic low back pain: Cochrane systematic review and meta-analysis. BMJ, 350. doi: http://dx.doi.org/10.1136/bmj.h444

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

4. Juratli, S. M., Franklin, G. M., Mirza, S. K., Wickizer, T. M., & Fulton-Kehoe, D. (2006). Lumbar fusion outcomes in Washington State worker's compensation. Spine, 31, 2715-2723.

 

Date of publication: April 27, 2012

Date of last modification: November 28, 2016

Murray J. McAllister, PsyD, is the executive director of the Institute for Chronic Pain (ICP). The ICP is an educational and public policy think tank. Its mission is to lead the field in making pain management more empirically supported. Additionally, the ICP provides Academic quality information on chronic pain that is approachable to patients and their families. Dr. McAllister is also the clinical director of pain services for Courage Kenny Rehabilitation Institute (CKRI), part of Allina Health, in Minneapolis, MN. Among other services, CKRI provides chronic pain rehabilitation services on a residential and outpatient basis.

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