New approaches to treatment of chronic pain: a review of multidisciplinary pain clinics and pain centers.

The Center for pain Studies of the Rehabilitation Institute of Chicago(fomerly known as the Low Back and Pain Clinic)has developed a multidisciplinary program for the management of chronic pain. Typically patients present a variety of chronic pain syndromes, most frequently low back pain, which have not responded to previous treatment including surgery, physical therapy, medication, vogue therapies, and other pain management programs. Patient capability to engage in normal daily activities such as standing, walking, sitting, lifting, etc. is often limited; most are unable to work or carry on pre-injury activities. Psychological ramifications of chronic pain appear frequently as a retreat from responsibility by the patient for his own welfare, manifested by distinct behaviour patterns (measurable on the MMPI); however, the ability of the patient to cope with chronic pain is largely a function of his ability to cope with other stresses prior to onset of pain. The patient's physical and psychological status alters his relationships with spouse and children, straining family well-being. Economic factors often occasion additional alteration in personal and family relations. Frequently a spouse not employed outside the home goes to work. Compensation programs and aid from public agencies may provide insufficient support or, conversely, compensation practices may establish perverse incentives toward recovery by providing the patient with net income equal to or greater than normally received. Admission to the Pain Clinic is determined by a two-day outpatient evaluation, assessing patient suitability for the multidisciplinary inpatient program by physical and psychological examinations, physical therapy and vocational therapy evaluations, interviews, and appropriate tests deemed necessary. The inpatient program consists of a four-week intensive education and treatment experience, utilizing injection techniques, physical therapy, relaxation techniques, family intervention, psychological services, vocational counseling and placement, and other approaches within the scope of the clinical facilities. Program efficacy is calculated by means of computerized analysis of the pain patient self-assessmemt questionnaire, which measures chronic pain in terms of severity and duration, and of performance of daily activities (standing, lifting, walking, sitting, etc.) with the RIC Rehabilitation Information System (REHABIS). Patient pain perception and tolerance