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  • Interdisciplinary Rehab Improves Function, Quality of Life for Individuals With Chronic Pain

    Amid a national conversation about how to safely treat chronic pain comes a new study that reinforces the idea that interdisciplinary rehabilitation can improve function and quality of life for individuals with chronic pain, even in instances when significant pain reduction itself is not possible.

    In an article published in Pain Research and Treatment, researchers from the Mayo Clinic Department of Pain Medicine in Jacksonville, Florida, tracked functional outcomes among 132 patients enrolled in a 3-week interdisciplinary rehabilitation program for individuals with chronic pain. Authors relied on the 6-minute walk test (6mWT) as a primary outcome, accompanied by results from the Canadian Occupational Performance Measure (COPM), a semi-structured interview process designed to capture limitations in and attitudes about activities of daily living.

    The clinic's pain rehabilitation center program involves physical therapists (PTs), occupational therapists (OTs), and pain psychologists who oversee a 5-day-a-week program that lasts 3 weeks. To qualify for the program, patients must have expressed an interest in improving daily function, and a willingness to taper and cease all pain medications and behaviors.

    The physical therapy portion of the approach involves separate sessions focused on stretching and coordination (15-20 minutes/day), cardio training (20-30 minutes/day), and strength training (45-60 minutes/day). Sessions led by OTs include group and individual work focused on "balance of daily activity with modification as needed to increase functional independence and participation in life roles," as well as biofeedback and educational sessions on breathing and muscle relaxation. Pain psychologists lead up to 3 group therapy sessions a day on a range of issues including cognitive coping skills, pain behaviors, personal responsibility, sleep, stress, and withdrawal.

    Participants had a primary diagnosis of central sensitization syndrome, with 30% reporting fibromyalgia, 20% low back pain, 11% abdominal pain, 4% headache, and 35% mixed or other. Participants were mostly female (114 of the 132 tracked), and 89% of the group was white. Average pain duration was 10.9 years, with a mean numeric pain score of 6.4 at admission and 4.9 at dismissal.

    What researchers found was that by the end of the rehabilitation program, patients demonstrated a 39% improvement in functional capacity as measured by the 6mWT—from an average of 375 meters to 523 meters. This functional improvement was accompanied by marked gains in patient perceptions of quality-of-life issues captured through the COPM, which uses a 10-point scale to measure patient-reported ability to perform activities, and satisfaction with those abilities. At admission, the average ability and satisfaction scores were 3.4 and 2.4, respectively. By conclusion of the program, both average scores had climbed to 7.5 out of 10.

    "In many cases of chronic pain, significant pain reduction is not possible, whereas increasing function and quality of life is a reasonable and achievable goal," authors write. "Interdisciplinary pain rehabilitation programs have been successful in the rehabilitation of people with chronic pain."

    The study on interdisciplinary work to improve function arrives not long after publication of a Dutch study that found similar improvements that continued to register as much as 24 months after discharge from a multidisciplinary treatment program. That study also looked at pain ratings, employment, and use of health care providers.

    The articles arrive at a time when the US Centers for Disease Control and Prevention, the National Institutes of Health, and the White House are focusing initiatives and recommendations on the treatment of pain as it relates to a national epidemic of opioid abuse and heroin use. APTA has added its voice to this effort though its national #ChoosePT campaign to promote physical therapy as a safe and effective alternative to the use of opioids in the treatment of pain.

    Housed at MoveForwardPT.com/ChoosePT, the #ChoosePT campaign will unfold throughout 2016 and include national online advertising, TV and radio public service announcements, and other targeted advertising and media outreach. Want to learn more about the PT's role in pain treatment? Visit the APTA Learning Center and check out "The Puzzle of Pain: Empowering Your Patient to Put the Pieces Together" and other courses related to dry needling, neck pain, and pelvic pain.

    Research-related stories featured in PT in Motion News are intended to highlight a topic of interest only and do not constitute an endorsement by APTA. For synthesized research and evidence-based practice information, visit the association's PTNow website.

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