Multidisciplinary treatment of chronic pain with disability

BACKGROUND AND OBJECTIVE: Disabling chronic pain is especially devastating among working population and, in many cases, it does not respond to conventional therapies. In chronic pain, the importance of psychosocial and occupational factors, in addition to biological ones, has prompted the development of successful multidisciplinary treatment programmes in various countries. We assessed the outcome of a multidisciplinary therapeutic program for work-disabled selected patients with chronic pain refractory to conventional treatment. PATIENTS AND METHOD: The study included 70 patients (58 women, mean age [SD]: 42 [9] years) with chronic pain and sick leave (mean [SD]: 7 [4] months of work disability) diagnosed with fibromyalgia (51%), chronic low back pain (16%), regional myofascial pain (15%),: cervicocraneal syndrome (3%), anquilosing spondylitis (3%), and other conditions (12%). All patients had received previous pharmacological treatment, physical therapy and/or other measures (surgery in 12% cases) without improvement. All patients underwent an intensive multidisciplinary treatment of 4 weeks' duration including medical techniques for pain control, cognitive-behavioural therapy, physical therapy, and occupational therapy. Average follow-up was 10 (4) months (1-24 months) post-discharge. RESULTS: Significant improvements were observed with regard to all relevant variables, as reflected in pre an post-discharge measures: pain (Visual-Analogue Scale 1-10 cm): 7.4 (1.5) versus 3.2 (2) (p < 0.01); anxiety (HARS), 19 (7) versus 14 (8) (p < 0.01); depression (BDI), 16 (8) versus 10 (8) (p < 0.01); functional ability (HAQ), 1.6 (0.4) versus 0.6 (0.5) (p < 0.001). At discharge, 73% of patients returned to work. In addition, 69% of treated patients maintained the acquired improvement and their employment status at the end of follow-up. CONCLUSION: Multidisciplinary treatment of chronic pain with special attention to work return is useful for selected patients with a disabling chronic pain syndrome refractory to conventional treatment.