CHRONIC PAIN MANAGEMENT PROGRAM

The Chronic Pain Management Program is a highly structured, intensive, time-limited treatment program designed to help a patient obtain the highest level of individual, social, and occupational functioning possible.  This is accomplished through the use of a interdisciplinary treatment team which brings to bear a collaborative effort to address the myriad of factors contributing to the patient’s pain perceptions and response. 

The program requires the patient to take an active role in his or her own treatment.  Through a variety of modalities which may include physical therapy, biofeedback, family therapy, hypnotherapy, educational classes, psychological counseling, vocational counseling and medical management, patients are taught to take responsibility for the management of their pain.  This involves increasing the patient’s pain threshold, reducing their focus on pain and stress reduction skills, and helping them increases their activity level. 

Upon being referred into the Chronic Pain Management Program, the patient will be evaluated by a psychologist, physician, and physical therapist.  These evaluations will be used to generate an individualized treatment plan for the patient.  The treatment plan will be multidisciplinary and will be specific to the patient’s individual needs.  At this time the patient will be assigned a case-manager with the designated responsibility of coordinating treatments, monitoring progress, and facilitating communication within the treatment team and to the referral source.  The treatment plan will be reviewed by the treatment team on a weekly basis. 

The treatment team includes: 

• physical therapist,
• psychologist,
• physician,
• social worker,
• chemical dependency counselor,
• case manager, and
• vocational counselor.

Therapeutic activities include:

• therapeutic exercise
• kinetic activity
• aquatic therapy
• biofeedback training
• self-hypnosis training
• psychoeducational classes
• training in activities of daily living
• individual counseling
• group counseling                                          
• medical management

                                                PROGRAM ACCREDITATION

NTPRC’s Chronic Pain Management Program is one of the few programs in the state of Texas accredited by both CARF (the Rehabilitation Accreditation Commission) and the American Academy of Pain Management (AAPM).  CARF and AAPM are the two premier accrediting agencies for chronic pain management programs.  Both require lengthy on-site surveys and strict compliance with standards of practice.  NTPRC has consistently shown a high level of compliance with these standards, resulting in 3-year terms of accreditation, the longest term of accreditation given by either agency.

WHO SHOULD BE REFERRED TO THE

CHRONIC PAIN MANAGEMENT PROGRAM?

According to the Official Disability Guidelines, the treatment guidelines adopted by the Texas Department of Insurance’s Division of Workers’ Compensation, a referral to a chronic pain management should be considered when:

1. Previous methods of treating the chronic pain have been unsuccessful,
2. The patient has a significant loss of ability to function independently 

      resulting from the chronic pain,

3. The patient is not a candidate where surgery would clearly be warranted,

And

4. The patient exhibits motivation to change.  (www.odg-twc.com/odgtwc/pain.htm#Chronicpainprograms)

WHEN SHOULD A PATIENT BE REFERRED TO A CHRONIC PAIN PROGRAM?

A referral to a chronic pain management program should be considered as quickly as they meet the aforementioned criteria.  The Official Disability Guidelines state, “The likelihood of return to work diminishes significantly after approximately 3 months of sick leave.  It is now being suggested that there is a place for interdisciplinary programs at a stage in treatment prior to the development of permanent disability, and this may be at a period of no later than 3 to 6 months after a disabling injury.”  (emphasis supplied) (www.odg-twc.com/odgtwc/pain.htm#Chronicpainprograms)  The ODG also quotes an article in the Study in Occupational and Environmental Medicine that shows only about 50% of those off work after 3 months eventually returned to work (1996 Jul; 53(7):488-94). 

The American College of Occupational and Environmental Medicine (ACOEM) echoes the need for early intervention.  They note, “Persons returning to work in six months or less after injury tend to have the best outcomes.  Persons who have been out of work for a year or more tend to have poor return-to-work outcomes…early intervention may increase successful return to work.”  (Occupational Medicine Practice Guidelines, p. 113).

IS THIS PAIN MANAGEMENT TREATMENT USUALLY SUCCESSFUL?

Yes, according to the Official Disability Guidelines’ literature review.  They report, “interdisciplinary/multidisciplinary care models for treatment of chronic pain may be the most effective way to treat this condition.”  (www.odg-twc.com/odgtwc/pain.htm#Chronicpainprograms)   The ACOEM also reports, “Research suggests that multidisciplinary care is beneficial for most persons with chronic pain, and likely should be considered the treatment of choice for persons who are at risk for, or who have chronic pain and disability.”  (emphasis supplied)  (Occupational Medicine Practice Guidelines, p. 114)

Our return-to-work statistics compare, reported in the next section, compare favorably to other multidisciplinary chronic pain management programs and very favorably to other treatment modalities, such as spine surgery, spinal stimulators or other conventional medical treatments.

Treatment of chronic pain patients in a multidisciplinary chronic pain center has been shown to be 9 times more const-effective than conservative medical treatment and 3.6 times more cost-effective than surgical treatment in helping patients return to work.  (“Clinical outcome and economic evaluation of multidisciplinary pain centers.”  Okifuji, Akiko; Turk, Dennis; Kalauokalani, Donna  in  Handbook of Pain Syndromes by Block, Kremer and Fernandez.)

SUMMARY OF NTPRC’S CHRONIC PAIN MANAGEMENT PROGRAM TREATMENT OUTCOME DATA

Average Time Since Date of Injury:                        33 Months

Patient Satisfaction  

• 97% of Patients would recommend North Texas Pain Recovery Center to a Friend.

Subjective Pain Level

• Patients saw a 33% reduction in Pain Level

Pain Tolerance

• 68% reported an increase in their ability to tolerate pain.

Functional Abilities

• 245% increase in cardio-endurance.

• 131% increase in strength.

Psychological Factors

• 100% of depressed patients saw a significant decrease in depressive symptomology.

Referral Sources

• 100% reported they were “highly satisfied” or “satisfied” with their patient’s treatment at NTPRC.

In a 1 Year Follow-Up

• 86 % reported they need very little or no help with daily activities.

• Only 4% reported a reoccurrence of severe depression or anxiety.

Return to Work

77% of NTPRC’s pain management patients (who were not retired) returned to work.

This compares favorably to a 67% return-to-work rate that been reported nation-wide for multidisciplinary chronic pain programs.  It is also much better than 36% return-to-work rate for chronic pain syndrome patients who have spinal surgery, the 20% return-to-work rate for repeated spinal surgery, the 25% return to work rate for patients wit spinal cord stimulators, or the 25% return to work rate for those patients treated with other conventional medical treatments.  (“Clinical outcome and economic evaluation of multidisciplinary pain centers.”  Okifuji, Akiko; Turk, Dennis; Kalauokalani, Donna  in  Handbook of Pain Syndromes by Block, Kremer and Fernandez.)

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Last modified: 09/09/07