理学療法と理学リハビリテーションのジャーナル

International Quality Standards Greatly Enhance Effectiveness of Spinal Interdisciplinary Chronic Pain Program

Abstract

Fernando Salvat, Marcela Parada, Sol Cavanagh and Honorio Pueyrredon

Introduction: Chronic pain is an important and costly health problem worldwide. Unfortunately, most traditional medical treatments for chronic pain focus exclusively on reducing or managing pain sensations. If left untreated, pain can lead to serious emotional and physical complaints such as depression, sleeping disorders, immune suppression, eating disorders, cognitive impairments and other long-term deleterious effects. The aim of this study is to describe outcomes observed in a patients suffering from chronic pain, treated at the FLENI interdisciplinary outpatient pain rehabilitation program (IOPRP) during an eight-year period, while working under international standards. Methods: We report results of an interdisciplinary, 16-session chronic pain treatment program, in 1176 patients followed as outpatients at our clinic, between January 2006 and December 2014. A battery of self-reported questionnaires was completed at the beginning and end of the program; follow up visits were scheduled three months and one year after discharge. Treatment included pain medication, physical and occupational therapy, as well as cognitive and behavioral techniques for pain and stress management. Results: Patient demographics were as follows: mean age was 55.76 ± 0.44 years (range 18-98 years); 68.9% were females (n=810); 302 patients had chronic cervical pain (25.7%) and 874 chronic lumbar pain (74.3%). IOPRP at baseline showed substantial pain problems (VAS 5.66 ± 0.07), poor quality of life (SF36, 41.9 ± 0.54), subclinical insomnia (ISI 11.31 ± 0.26), mild mood disturbance (BECK 13.87 ± 0.24) and excess weight (BMI 27.52 ± 0.20). At the end of the program, statistically significant improvement (p<0.05) was observed on SF-36 (8 domains), EVA, RMT, ODI, BECK, HAQ and ISI. Discussion: Results indicated not only that application of an IOPRP is feasible in Argentina, but also that results were uniform and sustained throughout the study period. Based on our experience, we encourage other centers to treat chronic pain in an interdisciplinary fashion, following international quality standards.