Chronic pain is a pain lasting beyond six months secondary to a condition affecting either a specific part of the body or the whole body. The standard modalities of treatment such as rest, medications and surgery do not provide adequate benefit for patients with chronic pain. Persistent chronic pain can result in narcotic dependence, insomnia, sexual dysfunction, physical weakness, mood disturbance, and depression. This condition is known as chronic pain syndrome.
In certain cases, chronic pain syndrome may progress to a more severe condition known as catastrophic chronic pain syndrome (CCPS).
Hyperalgesia is a condition characterized by increased sensitivity to the pain that can be secondary to chronic pain syndromes or drugs such as narcotics and benzodiazepines.
Chronic pain syndrome may be associated with various disease conditions including:
- Low back pain
- Neck pain
- Complex regional pain syndrome (CRPS)
- Nerve damage
- Multiple sclerosis
- Gastrointestinal illness
- Joint degeneration
- Reflex sympathetic dystrophy (RSD)
- Other chronic medical conditions
The objective of treatment is to reduce or eliminate the pain; by concentrating on the psychological and physical factors affecting the individual, through a multidisciplinary team approach. The basic steps in the treatment of chronic pain syndrome and CCPS include:
- Adopt a biopsychosocial model of patient care: After chronic pain syndrome or CCPS is diagnosed, a special pain management team is organized comprised of doctors and therapists with good communication skills to ensure a rapid and precise treatment. The team is usually specialized in gym and aquatic exercise, stress management, diet, substance dependence, medical detoxification, cognitive therapy, psychotherapy, massage, family therapy and other relevant specialties. This approach is also known as pain rehabilitation.
- Prevent worsening of the condition: In cases of CCPS standard pharmacologic agents are not very effective. Long-term use of narcotic therapy can cause opioid-induced hyperalgesia, addiction, constipation, sleep disorders, and a decrease in testosterone levels. Therefore, in these patient’s opioid and benzodiazepine detoxification may be recommended. In contrast to normal pain treatment, excessive rest can result in muscular atrophy and weight gain in patients with CCPS. Therefore, physical therapy or regular exercise is recommended in these patients.
- Medical and psychological history of the patient: Prior to initiation of treatment, a complete medical history of the patient including history of childhood abuse, addiction, previous injuries, and details of any previous therapies with medical records should be obtained. Along with this a psychological history including family expectations, work expectations, and any other data essential for psychotherapy should be obtained.
- Treat the syndrome: In pain rehabilitation, the underlying condition is treated rather than treating only the pain. Improvement in symptoms helps the patient to learn self-management of daily activities, stress, catastrophic thinking and also helps in opioid detoxification. Pain syndromes involve various factors that induce hyperalgesia that include excessive use of opioids, depression, cognitive distortions and inactivity. Therefore, narcotic detoxification, cognitive-behavioral therapy and exercise are an integral part of CCPS treatment.
Pain rehabilitation includes various interventions such as muscle reactivation, physical therapy, biofeedback training, education classes, psychotherapy, nutritional instruction, family counseling, chemical detoxification and medical management intended to reduce pain and improve function in individuals suffering from chronic pain and other related conditions. Pain rehabilitation programs may last from 6 days to 6 weeks or longer, depending upon the condition of the patient.
Types of pain rehabilitation
Based on the severity of the condition, involvement of the medical staff, and the condition of the patient, pain rehabilitation programs can be categorized into three types:
- Primary or acute care
- Secondary rehabilitation
- Tertiary rehabilitation
Primary care includes simple non-surgical interventions for the management of symptoms causing pain. This program may last for 6-8 weeks.
Secondary rehabilitation is given to patients not responding to primary care; it requires a large team of doctors and therapists from different specialties and the treatment lasts for 4-6 months.
Tertiary rehabilitation is given to patients with critical conditions; it employs advance facilities and focuses on the different aspects and requirements of the individual patient.