Multidisciplinary Rehabilitation for Individuals with Chronic Musculoskeletal Pain
This article on the multidisciplinary approach to the treatment of musculoskeletal pain was of particular interest to me. In my practice, I deal with many patients who have chronic pain. Sometimes the pain the experience is an element of physical disease. Sometimes the pain is an element of psychosocial distress. Often times my severely depressed patients present which chronic pain issues. Depending on the patient's insight into his or her disease, it may be easy to address the psychological elements of pain. Other times, patients seek relief via escalating doses of narcotic pain medication, whether prescribed or illicit, in an attempt to numb the pain, caring little from where the pain comes. There is often times a disconnect between me and the patient's medical provider regarding treatment, so an article which recommended a multidisciplinary approach was of specific interest to me. In this article, it was noted that in more than 90% of the cases of chronic musculoskeletal pain there can be identified no organic reason for the pain. The researchers identified several associated secondary stressors with chronic pain such as unemployment, interpersonal problems, sleep disruption and psychosocial disruption. Depressio
The study results showed that many issues tend to effect pain intensity, pain perception and functional health status. Sometimes these patients's complaints are vague and dismissed as psychosomatic. The patients were then evaluated using self-reporting measures. The researchers believed that the lack of physical fitness and the loss of social activity (even if it was only participation in the rehabilitation program) influenced several aspects of the patients' lives. For the study, 143 individuals between the ages of 20-67 with chronic musculoskeletal pain (> 3 month) were enrolled in a 57 week long rehabilitation program at a center in Norway. Anxiety related to pain can often be traced to the patient's fear that the pain represents an underlying element on ongoing damage to the body. For this reason, the researchers believed that the influence of psychosocial factors on function tend to vary depending on the activity in which the patients are engaged. When these patients were engaged in social activities and worked toward management of the pain, rather than simply treatment with medication, their functional scores improved as did their perception of the severity of the pain and associated depression and anxiety. The program was based on a biopsychosocial theoretical model and the participants were originally enrolled in a 5 week intensive program where they spent 6 hours per day 4 days per week in the rehabilitation. It is interesting to note that there was a relative decline in the health and fitness scores and an increase in the pain scores which were assessed at the 57th or final week of the study. Now I understand even better the effect of depression, anxiety and previous trauma on the pain and will carry this with me into future interactions with my patients. I have always understood the psychological component to pain. I found this study particularly helpful in validating my beliefs surrounding the treatment of patients with chronic non-specific musculoskeletal pain. After the first 5 weeks, the patients then entered a 52 week follow up program and would attend rehabilitation 6 hors a day, anywhere for 1-3 days per week. The study demonstrated that the consequences of chronic pain on life function tend to depend on the individual and his or her cumulative life experience more than anything else.
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