For a chronic pain intervention to be successful both biological knowledge and psychosocial knowledge is necessary. The biopsychosocial model is the basis of pain rehabilitation (Stanos & Hoole, 2006). What is the biopsychosocial model and how does it relate to chronic pain?
In the beginning, researchers believed in a sole component to pain, the biomedical model, which states that the larger the extent of tissue damage the greater the pain. However this model did not help alleviate or manage pain. Medication and medical treatment alone failed to treat chronic pain in its entirety (McCracken & Turk, 2002). Medical treatment is effective for 30% to 40% of patients with chronic pain with the rest supporting that medication helps in alleviating around half of their pain (Turk, 2002). Surgery for chronic pain patients (mainly to the spine) results in minimal gains while biological factors such as tissue damage explain only part of the pain experience (Adams, Poole & Richardson, 2006).
The complexity of chronic pain and the lack of effective pharmacological treatments have revealed the need for multi-dimensional approaches in treatment combining both medical and psychological approaches (McCracken & Turk, 2002). Many factors are required in pain rehabilitation such as exercise, hydrotherapy, psychological support and physiotherapy. The biopsychosocial model presumes that the body as well as one's reactions to external and internal triggers play a role in the pain sensation. For successful pain management to take place, a combination of pharmacotherapy, surgery, learning new skills, changing one's perception of pain, reinforcement and psychological support of the patient, their immediate family and the reversal of pain from enemy to ally is needed.
Chronic pain patients are often subjected to numerous failed treatment attempts. As a result this failure prevents the person from being actively energetic in his role as a patient and instead becomes passive and disheartened with lots of negative consequences on his/her life.
Knowledge derived from research suggests that treatment programmes for chronic pain can, in general, be effective and can reduce the severity of symptoms in a large number of patients. However, none of the current treatments alone can successfully eradicate pain for patients (Turk, 2002). The programmes that are most successful in limiting pain symptoms are pain rehabilitation programs (PRPs). But what exactly are these?
Pain Rehabilitation Programs incorporate both medical care (e.g. medication, surgery, physiotherapy etc), and psychological therapies, in addition to exercise, hydrotherapy and social support. A typical day at a rehabilitation programme would entail a doctor's appointment, psychological therapy, physiotherapy, outdoor exercise and relaxation training.
Pain Rehabilitation Programs incorporate both medical care (e.g. medication, surgery, physiotherapy etc), and psychological therapies, in addition to exercise, hydrotherapy and social support. A typical day at a rehabilitation programme would entail a doctor's appointment, psychological therapy, physiotherapy, outdoor exercise and relaxation training.
Such treatment programmes work through collaboration, to assess individualised patient needs and have common treatment goals. RPRs include daily team meetings where a patient's progress is assessed and potential difficulties and barriers to treatment are targeted and approached from a different angle. In some instances, treatment goals are altered to accommodate personal needs. The teams usually consists of a doctor specialising in pain, a psychologist specialising in pain, a specialist nurse and a number of other specialists such as a trainer, physiotherapist, social worker etc. Patients follow a personally tailored daily routine ranging from 3 to 8 weeks lasting between 4 and 8 hrs daily.
PRPs conduct in depth medical and psychological assessments. Medical assessment entails a musculoskeletal assessment, sensory assessment, detailed medical history, medication and treatment taken to date. Both the doctor and the psychologist make a note of pain behaviour, difficulties in the patient's life as a result of pain, reinforcement or secondary gains associated to the "sick role", anxiety and depression ratings. This approach increases patient motivation, reinforces the patient and helps make the most of treatment.
Rehabilitation Programmes offer patients an opportunity to freely express their feelings in a safe, non judgemental environment whereby no tight time- frame is necessary for treatment. The multi-centred approach offers patients a united and holistic treatment approach that aids the patient take play an active role in their own treatment.
