— DEAR MAYO CLINIC: Since a car accident three years ago, I’ve had chronic back pain. Medication is no longer working. The pain makes it hard for me to get out of the house. I can’t do the activities and hobbies I used to because I’m too uncomfortable. Would a pain rehabilitation program be a good next step? If so, what can I expect?
ANSWER: From your description, it sounds like you may benefit from a pain rehabilitation program. Because chronic pain cannot be eliminated, the goal of these programs is not to get rid of pain. Instead, they can help you take control of your life in spite of the pain.
Pain rehabilitation programs usually involve experts from many medical backgrounds. They bring together physicians, psychologists, nurses, physical and occupational therapists and pharmacists to help participants improve their quality of life.
Many of these programs are intensive and include full-day schedules that last several weeks. This may seem like a big commitment. But participating in this kind of comprehensive program can give you the tools and confidence you need to start enjoying life again.
Pain rehabilitation programs involve a variety of activities. Most have daily physical and occupational therapy sessions. Planning also plays a key role. For example, at Mayo Clinic, we ask participants to set a structure for their days that they can follow even if they have pain. This technique allows people to get past the tendency of waiting to make plans until they see how much pain they have on a certain day. Instead, the mindset is one that sets a plan in motion, knowing there may be some pain.
We also ask them to develop a plan for difficult days. Then on days when pain is more troublesome, they have in mind activities or support that they know will help. That may be taking a walk, going to see a friend or taking a drive. It involves making a conscious effort to engage in activities that help and avoid behaviors that can make pain worse, like staying in bed, doing too much or avoiding other people.
Spending time with others who are dealing with pain issues also can be a benefit of a pain rehabilitation program. Even people who have supportive family members may feel isolated when they have long-term pain. Others in similar situations can offer ideas that may help manage pain, increase confidence and provide encouragement. With the support of peers, as well as the medical team, many participants feel better equipped to make changes that are hard to do alone.
Most people who enter pain rehabilitation programs take pain medication. With long-term use, these drugs may eventually fail to lessen pain and can actually make pain worse. In many programs, participants are slowly tapered off pain medications. Plenty of support is provided to help people through the process. At the same time, participants gain skills that allow them to manage pain and get back into daily activities. While they may be nervous about tapering off the medications, patients often describe feeling and functioning better and thinking more clearly.
Although many people do have less pain after they finish a pain rehabilitation program, that is not the primary goal. Many factors can affect a person’s pain level, from the weather to stress. Instead, pain rehabilitation programs teach participants to focus on the things they can control.
Despite having long-standing chronic pain, about 90 percent of participants complete Mayo Clinic’s program. About 80 percent report improved functioning, better mood and decreased pain. Most do not go back to taking pain medications. In many cases, those who come into pain rehabilitation programs willing to try the various therapies offered and who follow through on their team’s recommendations are able to get back to their day-to-day routines and begin to enjoy life again. — Cynthia Townsend, Ph.D, Pain Rehabilitation Center, Mayo Clinic, Rochester, Minn.
Medical Edge from Mayo Clinic is an educational resource and doesn’t replace regular medical care. Email a question to firstname.lastname@example.org. For more information, visit www.mayoclinic.org.