"Successful treatment
addresses issues of
sleep,
fatigue,
social isolation
and
emotional barriers
to returning to work."

Newsletter Index:
Page 1: Effective Approaches to Pain Management | Fibromyalgia and Pilates
Page 2: Breaking the Pain Cycle
Page 3: Multidisciplinary Functional Restoration Approach
Page 4: Acupuncture Provides Long-Term Relief of Low Back Pain

Multidisciplinary Functional
Restoration Approach

It is well known that patients with the full chronic pain syndrome have little likelihood of returning to work if treated with traditional passive modalities solely addressing physical pathology. Yet, medical literature and extensive nation-wide experience using a comprehensive approach are clear: many patients can return to work if their problems are addressed systematic ally.

Treatment begins with the restoration of physical fitness and function. We utilize aggressive physical and occupational therapy, aerobic and strengthening exercises, pool therapy, stretching and deep tissue massage. The patient should receive regular pain-relieving therapies, such as acupuncture and massage to combat exercise-induced flare-ups of pain. This allows patients sufficient relief so that they can achieve the necessary fitness, strength, and flexibility at a more rapid rate. The goal is to achieve sufficient overall aerobic capacity, muscle strength, and increased range of motion of affected body areas so that the patient can safely begin work hardening, the next phase of readying the patient to return
to work.

Expert medication management is key to ensuring a successful outcome.

Mood disorders are common and severely limit the likelihood of recovery from chronic pain. Patients with chronic pain problems require expert medication management, which involves the reduction or elimination of undesirable medications and the careful, but aggressive, use of antidepressants and related agents as appropriate. In spite of the many difficulties antidepressant therapy presents, more often than not it is the crucial missing link in enabling patients to withstand the rigors of functional restoration.

The patient should learn self-management and improved coping skills in educational classes and individual psychotherapy. Relaxation and pain-management skills often allow the patient to function at a much higher level despite ongoing pain. Patients often credit these skills with allowing them to exercise at higher levels and so achieve fitness and work hardening goals more quickly.

Finally, successful treatment and return to work requires that we address issues of sleep, fatigue, social isolation, withdrawal from pleasurable activities, and emotional barriers to returning to work. Medical sleep disorders occur in some patients with chronic pain and must be identified and addressed before the patient is likely to improve.

Treatment commonly occurs in three phases. First, the patient begins an overall conditioning program consisting of aerobic, stretching and strengthening exercises. Acupuncture and deep tissue massage are given frequently for pain relief. Medication management is initiated. Introductory pain management classes are offered. Behavioral sessions introduce the patient to new coping skills and other self-management techniques.

In the second phase, the intensity of cardiovascular, stretching, and strengthening exercises increases, and the patient is expected to become more independent with exercise. When therapeutic doses of desirable medications are achieved, patients begin to experience the benefit of these medication changes. Specific work hardening and conditioning tasks are then introduced.

The third phase begins when the patient has achieved sufficient fitness, strength, and range of motion to be able to
engage safely in intensive work hardening and work conditioning. Other aspects of the program are de-emphasized as the patient is prepared to return to work at the appropriate level. At Care Center, our multidisciplinary functional approach to restoration, combined with the emphasis on relapse prevention, predisposes patients to a high probability of success. CCRPM

Newsletter Index:
Page 1: Effective Approaches to Pain Management | Fibromyalgia and Pilates
Page 2: Breaking the Pain Cycle
Page 3: Multidisciplinary Functional Restoration Approach
Page 4: Acupuncture Provides Long-term Relief of Low Back Pain