Pain rehabilitation – outcome of an 8-week rehabilitation program

Abstract

Abstract. The prevalence of persistent pain has been estimated to be around 20-50% in a normal population. Musculoskeletal related pain is the most common form of persistent pain. In patients with persistent pain there are alterations in the peripheral as well as the central nervous system and patients develop a dysfunctional behaviour which, in many cases, leads to severe suffering for the patient. In the European countries an increasing problem has emerged consisting of more people on long-term sick-leave, increased number of early retirements and high social costs. After an 8-week structured multiprofessional rehabilitation programme at the Karolinska Institute in Stockholm, Sweden 63% of patients with longstanding non-malignant pain returned to work and half of the patients were still at work at a 6-year follow-up. Half of the patients reported pain reduction and almost half of the patients had reduced their consumption of analgesics. The rehabilitation program was estimated as economically beneficial on a society level. It is concluded that pain rehabilitation should have a multiprofessional approach. Pain rehabilitation programs are beneficial for the possibility for the patient to return to work pain and leads to pain reduction in the long run. Furthermore, they are beneficial from a socio-economical aspect. Key words: persistent musculoskeletal pain, multiprofessional rehabilitation program, return to work, socio-economic benefitThe prevalence of persistent pain is estimated to be 20 and even up to 50 % in the normal population (Brattberg et al., 1989;Andersson et al., 1993;Gerdle et al., 2004;Elliott et al., 1999;Brevik et al., 2006 Suffering from pain over a long period of time negatively affects a person's family life, spare time, economy, psychosocial well-being and ability to work. It also leads to rising costs for society. Rehabilitation in a structured program with a multiprofessional team has shown beneficial effects on sick-leave, disability pension and /or return to work. The clinical effectiveness of such programs has also been documented in systematic reviews (Malone, Strube, 1988;Flor et al., 1992;Morley et al., 1999;Karjalainen et al., 2001;Karjalainen et al., 1999;Guzmán et al., 2001;Nielson, Weir, 2001;Marhold et al., 2001;Oliver, 2001;Shonstein et al., 2003; SBU, 2000; SBU, 2006; SBU, 2010).The Department of Rehabilitation Medicine at Huddinge University Hospital in Stockholm, Sweden, offered an 8-week multiprofessional work-related rehabilitation program for patients on long-term sickleave suffering from persistent musculoskeletal related pain.The objectives of the clinical rehabilitation program were: 1) return-to-work, 2) increased activity level, and 3) reduced pain intensity.The 8-week medical and work-related multiprofessional rehabilitation program ran 7.5 hours a day and 5 days a week.The program consisted of 2 parts: A 3-week Impairment and Disability Evaluation Analysis (IDEA) and a 5-week work-related program.The idea of the IDEA included the different tools of the multiprofes...