This past summer, Minnesota Governor Mark Dayton signed into law an omnibus health and human services budget bill and in so doing he marked a significant milestone in the recent history of chronic pain management. The bill contained language, introduced by State Representative Deb Kiel and State Senator Jim Abler, authorizing the trial of a new payment arrangement through Medical Assistance, which makes it possible for state recipients of the public health insurance to receive care within an interdisciplinary chronic pain rehabilitation program.
A central tenet of chronic pain rehabilitation is that what initially caused your pain is often not now the only thing that's maintaining your pain on a chronic course. Let’s unpack this important statement. It’s no accident that healthcare providers commonly refer to chronic pain syndromes as complex chronic pain or complicated chronic pain.
When going to a pain clinic, there is one thing that patients should always keep in mind: It’s that not all pain clinics are alike.
More often than not, patients are referred to one or another type of clinic, without knowing that there are different types of clinics with different ways of treating chronic pain -- even when it comes to the same conditions. Moreover, the different types of clinics are not all similarly effective. Research on the effectiveness of different types of common treatments for chronic pain show wide variations in how effective they are.
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.