Rehabilitation facilities handle chronic pain in many different ways
Try cognitive-behavioral, holistic, or psychological approach
Rehabilitation facilities have a good opportunity to capitalize on a growing specialty area of treating chronic pain patients, both among their typical patient populations and in providing a program for workers’ compensation cases and the community at large.
Studies show that about two-thirds of spinal cord injury patients experience chronic pain, and a majority of traumatic brain injury patients also suffer from pain.1,2 Also, more rehab facilities are looking for niche markets to serve as obtaining reimbursement becomes more challenging. Treating patients for chronic pain, including those referred by workers’ compensation, is one way of becoming more competitive. It’s also a way for rehab providers to meet the needs of the rapidly increasing population of elderly people. Chronic pain problems increase as people age, and those people will need a health care provider who can help them manage their pain.
One national survey found that one in five older Americans takes analgesic pain medication several times a week or more, and most of those people had taken prescription pain medications for more than six months.3,4 Other studies estimate that up to 80% of people in nursing homes suffer from untreated pain.3,5-7
The American Geriatrics Society of New York City in recent years has focused on educating health care providers about the severe consequences of untreated chronic pain and how to assess and treat pain. (See guidelines for managing chronic pain, inserted in this issue.)
Treating chronic pain in a rehabilitation setting requires a multidisciplinary team approach, says Laura Schneeweis, MS, OTR, pain program manager at Northridge (CA) Hospital Medical Center. The hospital has a 26-bed rehab facility that provides both inpatient and outpatient chronic pain programs.
"The goal of our program is to enable each individual patient to return to meaningful daily functioning and to enhance the patient’s ability to effectively control their pain," Schneeweis says. Northridge’s program accomplishes that goal by following a cognitive-behavioral approach.
Other chronic pain programs take a holistic approach, focusing on helping patients cope with pain through interventions directed at the physical, psychological, emotional, and spiritual realms.
Pain patients experience social, work losses
"They are not just physical beings affected by pain," explains Jevelyn Verbic, RN, clinical nurse coordinator at Marianjoy RehabLink in Wheaton, IL. "They have psychological pain losses, work-related social issues, and we help them rebuild a life because they’ll never be what they were before they had this pain." Marianjoy RehabLink is a freestanding rehab hospital with stroke, head injury, spinal cord, pediatric, and neuromuscular programs.
A third chronic pain treatment approach involves the use of psychological interventions.
"Generally, this is teaching the person what we call self-regulation skills for pain so the person could use mental distraction or relaxation or they could restructure the way they look at things to decrease or cope with pain better," says Ralph Bruno, PhD, rehabilitation psychologist at Walton Rehabilitation Hospital in Augusta, GA.
What programs offer patients
Pain programs offer patients much-needed acceptance. Many chronic pain patients feel as though no one understands their suffering because they may look healthy on the outside. Many people have trouble believing that someone who looks healthy is experiencing chronic pain. Even health care professionals think poorly of chronic pain patients, Verbic says.
For instance, Marianjoy RehabLink conducted an informal survey of health care professionals in its facility, asking them to name three words that came to their minds when they thought about a chronic pain patient. The top three words chosen were malingerer, drug seeker, and faker.
"That was amazing to me," Verbic notes. "Not even health care professionals understand chronic pain, and there’s a bad stigma out there."
Chronic pain programs can help combat this stigma by educating staff about pain, its consequences, and its treatment. Comprehensive pain management programs can help improve chronic pain patients’ quality of life and reduce their dependence on opioid medications. One study of a multimodal pain rehabilitation program showed that patients reported a signifi -cant reduction in pain levels and in opioid use, as well as increased sleep, after the program. Those improvements continued during a follow-up period.8
In recent years, there has been a growing medical consensus that managing chronic pain requires a special expertise and is best approached in multidisciplinary treatment programs that focus on the pain itself and the impact of pain on a patient’s social, work, psychological, and spiritual life.9
Rehab facilities already have physical therapists and occupational therapists, and they often have a psychologist, social worker, physiatrist, nurses, and other health care professionals on staff. Facilities with that staffing mix are in an ideal situation to take on the project of starting a pain management program. Such a program likely will include attention to psychological, social, behavioral-cognitive, and other interventions that can help patients better cope with and manage their chronic pain. (See story on features of a chronic pain program, at right.)
The multidisciplinary approach works best because people with long-term chronic pain typically become depressed and more socially isolated if their pain and its side effects are untreated, says Verbic.
"The longer the person has pain, the more each problem will be increased, so they’ll have psychological problems such as anger issues or loss issues. And mentally they’re not getting as much stimulation because they’ve isolated themselves, and they have concentration issues," she explains. "We’re helping these patients get their lives back, and we’re helping them do it for themselves instead of going from one physician to another."
References
1. Rintala DH, Loubser PG, Castro J, et al. Chronic pain in a community-based sample of men with spinal cord injury: Prevalence, severity, and relationship with impairment, disability, handicap, and subjective well-being. Arch Phys Med Rehabil 1998; 79:604-614.
2. Lahz S, Bryant RA. Incidence of chronic pain follow -ing traumatic brain injury. Arch Phys Med Rehabil 1996; 77: 889-891.
3. AGS Panel on Chronic Pain in Older Persons. The management of chronic pain in older persons. JAGS 1998; 46:635-651.
4. Cooner E, Amorosi S. The Study of Pain and Older Americans. New York City: Louis Harris and Associates; 1997.
5. Ferrell BA, Ferrell BR, Posterweil D. Pain in the nursing home. J Am Geriatri Soc 1990; 38:409-414.
6. Roy R. A psychosocial perspective on chronic pain and depression in the elderly. Soc Work Health Care 1986; 12:27-36.
7. Ferrell BA, Ferrell BR, Rivera L. Pain in cognitively impaired nursing home patients. J Pain Symptom Manage 1995; 10:591-598.
8. Vines SW, Cox A, Nicoll L, Garrett S. Effects of a multimodal pain rehabilitation program: A pilot study. Rehabil Nurs 1996; 21:25-30.
9. Russo CM, Brose WG. Chronic pain. Annu Rev Med 1998; 49:123-133.
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