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What Is Chronic Pain Syndrome? Chronic Pain Syndrome (CPS) is a combination of six things:
Chronic Pain Chronic pain is different than acute pain or short-acting pain. Acute pain is a symptom of a medical problem, illness or injury, and is only temporary. Chronic pain is more than a symptom - it is an actual illness or medical problem that persists beyond the healing phase, usually three to six months, and has not responded to traditional medical treatment, such as rest, medicine, injections, physical therapy or surgery. With time the pain spreads and increases in intensity. Decreasing Function Function includes the ability to sit, stand, walk, climb, carry, bend, crawl, etc. CPS makes it much harder to physically perform these functions. Because of this, patients with CPS may have limitations at work or cannot work at all. They may be unable to participate in their hobbies or sports and often can no longer drive. Sometimes CPS becomes so severe that patients require canes or walkers and are unable to perform basic self-care activities. Decreasing Physical Abilities The six basic areas of physical abilities that are affected after CPS are strength, flexibility, endurance/stamina, balance (associated with falls), coordination and reaction time. Other areas that cause physical stress to the body are improper body mechanics, poor posture and excessive body weight. Emotional Stresses Some emotional stress such as anxiety (fear arising from the feeling that a situation is dangerous or unpleasant), depression (hopelessness, loss of energy, problems with concentration and not being able to sleep), frustration and anger may also develop with CPS. Psychosocial Issues Examples of psychosocial stresses and issues are increasing isolation that affects relationships with family and friends, financial strain due to unemployment, disability issues, legal issues, chemical dependency issues, marital issues and sleep problems. These changes often add to the pain problem as the patient continues to become less interested in physical activity and has more negative emotional experiences. Medicines Many patients with CPS take increasing amounts of narcotics and tranquilizers. Narcotics interfere with the production of endorphins, and tranquilizers interfere with REM sleep and accentuate depression. How Is CPS Treated? The rehabilitation model for CPS dictates that treatment does not resolve (1) the pain, and then the other components that make up CPS (items 2-6 in What is CPS?) automatically go away. In rehabilitation, patients with CPS work on 2-6, i.e., the physical, the functional, the emotional, the psychosocial and the medications and then the pain problem begins to improve. The treatment or rehabilitation plan, called a clinical pathway, usually involves contributions from more then one specialist. (This is referred to as a "multi-disciplinary" approach.) The treatment plan is carried out under the direction of a physician and typically includes a treatment coordinator (internal case manager), a physical therapist, a licensed medical counselor, biofeedback therapist, registered nurse and an exercise physiologist. The rehabilitation program must be structured and focus on educating the patient not "treating" the patient. Comprehensive Rehab Program Our comprehensive rehabilitation program is a multi-disciplinary, chronic pain education and functional restoration program. It is time limited, education-based, goal oriented and cost effective. The primary focus is to give the patient the skills/information needed to maximize their level of function and to move forward with their life. This program has the following components:
The key concepts for this program:
Back In Action Rehabilitation Progam What Type Of Follow-up Treatment Might Be Necessary? At the completion of the program patients are reassessed for their individual aftercare needs. If the patient has demonstrated functional progress and appears to be using the chronic pain concepts, we will typically recommend a follow-up appointment with the physical therapist, medical counselor, and the physician within one week of program completion and again at one month. If a patient needs to progress to a higher functional level, a work-conditioning program may be recommended.
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