Murray J. McAllister, PsyD
Murray J. McAllister, PsyD, is a pain psychologist and consults to health systems on improving pain. He is the editor and founder of the Institute for Chronic Pain (ICP). The ICP is an educational and public policy think tank. In its mission is to lead the field in making pain management more empirically supported, the ICP provides academic quality information on chronic pain that is approachable to patients and their families.
There is no one discipline within healthcare that specializes in chronic pain management. No one, for instance, can get an M.D. or a Ph.D. in pain management. Instead, many different types of healthcare providers can specialize in delivering chronic pain management services. In other words, there are different types of pain management specialists.
Opioid, or narcotic, pain medications are beneficial in many ways. Patients with pain from terminal cancer benefit from their use. Patients benefit from their short-term use when recovering from an acute injury or following a painful surgical procedure. However, the long-term use of opioid medications for chronic, noncancer pain remains quite controversial.
Most everyone has back pain at some point in their lives. At any given time, twenty-five percent of the population report having low back pain.1 Forty-three percent of the population report having neck pain.2
We live in an age of chronic health conditions. Chronic pain, diabetes, heart disease, inflammatory bowel disorders, obesity, and sleep apnea are just a few of the most common chronic conditions. Many patients and healthcare providers attempt to treat these conditions by solely medical approaches. It makes sense, of course. Many, if not most, of these conditions are medical conditions. So, it makes sense to take medications and get different types of medical procedures and surgeries in order to try to get better. These medical treatments are usually worthwhile to pursue.
What is a chronic pain rehabilitation program?
Chronic pain rehabilitation programs are a traditional type of chronic pain management. Sometimes also called functional restration programs, 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 with moderate-to-severe persistent pain who have come to accept that their pain is truly chronic and cannot be cured. So, they want to be able to engage in meaningful life activities 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, if taking them
- 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 patients to focus on what they can do to reduce pain and reduce the degree to which it impairs daily life.
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 as problematic as it used to be. 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. Some programs 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 decades, 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 moderate-to-severe, 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. Many are also taking opioids to manage their pain. 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.
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: August 28, 2022
About the author: Murray J. McAllister, PsyD, is a pain psychologist and consults to clinics and health systems on improving pain care. He is the founder and editor of the Institute for Chronic Pain.
Pain management is a catchall phrase used to describe multiple types of healthcare services for pain. Pain management can include the following types of services:
What is shoulder pain?
Shoulder pain is common. Sometimes, it occurs in an acute manner, such as in a sports injury or when it becomes dislocated. Other times, it comes and goes, such as when people have bursitis. Sometimes, it lasts longer. Tendinitis can continue for some time but can usually be improved with care. In most cases of chronic shoulder pain, it is due to osteoarthritis.
What is sciatica?
Sciatica is a common pain condition marked by pain, numbness and/or tingling beginning in the buttock and oftentimes extending down the leg, all the way to the foot.
What is reflex sympathetic dystrophy?
Reflex sympathetic dystrophy (RSD) is an uncommon nerve-related pain condition. It can occur in any body part, though it typically occurs in an arm or leg. It has a typical set of signs and symptoms in the affected body part:
What is post-surgical pain?
As the name implies, post-surgical pain is pain that occurs as a result of a surgical procedure. Post-surgical pain is normal when immediately following a surgery. Such pain is usually treated with the use of medications. As patients heal from the surgery, pain typically diminishes. In a surprising number of patients, however, pain continues long after the normal healing process is completed. As such, the pain becomes chronic. Post-surgical pain is typically considered chronic when it continues for longer than six months.