The Functional Restoration Program at Pasadena Rehabilitation Institute (PRI) has been designed to meet the needs of chronic pain patients in the current healthcare environment. Chronic pain is a debilitating, demoralizing and depressing condition that can compromise all aspects of patient’s life. Patients, their families, healthcare providers, employers and third party payers are left frustrated as pain reports continue and patients remain disabled even though multiple expensive treatments have been utilized. As an example, chronic low back pain accounts for the largest expenditures of healthcare costs with the poorest prognosis.
The Functional Restoration Program utilizes the biopsychosocial model combined with an interdisciplinary team approach and structured treatment goals to facilitate return to work and health, decrease pain and suffering, and decrease dependence on the healthcare system. Providers working within the biopsychosocial model, in addition to assessing the treating the biological aspects of the patient’s pain, also treat the complex interplay of behavioral and social factors that influence the patient’s pain. Furthermore, multiple providers working as an interdisciplinary team continuously collaborate in order to address the complex needs of each patient and meet structured treatment goals.
The Biopsychosocial Model
The experience of pain is a complex mix of interdependent factors that include biomedical, cognitive, behavioral, and social aspects. Treatment that focus only on the biomedical factors of chronic pain fail to address the complex set of interacting features affecting each patient. As a result, pain and disability persist while critical aspects of the patient’s condition remain unaddressed. For chronic pain patients biological factors may influence their psychological states and their psychological states may influence biological factors implicated in their pain. For example, chronic pain is closely associated with depression, whereas psychological factors can influence the autonomic nervous system, hormone production and brain structure and processes.
The Interdisciplinary Team Approach
Working within the biopsychosocial model, the interdisciplinary treatment team within the Functional Restoration Program collaborates to provide each patient with multiple modes of treatment to help him or her meet program goals. The treatment team includes a medical doctor (MD) specializing in pain management, a behavioral health practitioner (PH.D. Clinical Psychologist), a physical therapist (PT), and an occupational therapist (OT). Below is a description of each practitioner and the service they provide.
The MD is the medical director, responsible for each patient’s medical care. The MD takes care of all the medical needs of the patient. The MD also works to decrease the patient’s reliance on pain medication and healthcare utilization. In addition the MD educates the patients on his or her pain, working to decrease faulty pain beliefs and maladaptive pain behaviors.
Behavioral Health Practitioner
The Behavioral Health Practitioner (BHP) works with each patient to identify and treat the cognitive and behavioral barriers that are keeping the patient in a state of pain and disability. The BHP works to increase and expand the patient’s coping skills and to increase well behaviors. The BHP uses the cognitive-behavioral treatment modality in individual and group therapy as well as family therapy sessions.
The PT takes an active approach to rehabilitation and restoration of functionality. The PT uses treatment techniques that include postural training and body mechanics, exercise and reconditioning, and other indicated therapies applicable to each patient. Individual and group treatment is provided to increase endurance, tolerance, strength, range of motion and other physical parameters.
The OT is involved in both the physical and occupational aspects of the patient’s care, working with patients to restore activities of daily living and facilitate return to work and health. The OT works with each patient on whole body activities that closely approximate job demands, increasing the patient’s ability to return to work and helping patients return to preinjury levels of functioning.
In addition to the above services, providers also employ educational lectures on topics that include techniques for pain control, inappropriate use of medication, psychophysiology, stress reduction and the physiology of pain. In addition applied psychophysiology (biofeedback) is used to decrease stress and muscle tension while increasing relaxation. This technique helps patients learn the connection between their psychological state and physiological functioning as well as their ability to influence these processes. Furthermore, all providers employ an operant conditioning model, working together to reinforce patient well behaviors while not reinforcing pain behaviors. This model helps the patient un-learn maladaptive behaviors that have resulted from his or her chronic pain and to learn adaptive ones that leads to health. Finally, the patients are provided with case management, discharge planning and aftercare to facilitate their return to work and health.
The Functional Restoration Program carefully quantifies and continually measures each patient’s progress toward achievement of treatment goals. These goals include return to work and health through increasing functionality and activities of daily living; reducing reliance on health care by stabilizing medications and decreasing pain medications increasing adherence to the prescribed treatment, and increasing reliance on self; decreasing suffering by decreasing and removing psychological barriers implicated in each patient condition; and decreasing pain through the use of all of the above treatment modalities. Each patients has unique factors contributing to their progression through each of these goals, and through consistent collaboration, the interdisciplinary team works to help each patient achieve each of these goals.
The above treatment goals are quantified and measured. Through the use of quantitative tools, the treatment team monitors the progress of each patient. Using quantitative tools enables the treatment team to work efficiently with each patient to ensure progress through the treatment goals.
Through the use of the biopsychosocial models, an interdisciplinary treatment teams and quantifiable treatment goals, the Functional Restoration Program provide each patient with an unparalleled level of treatment to facilitate his or her return to work and health. Working together as a team, with the patient being the center and focus of the team, the practitioner and the patient work together to achieve treatment goals and improve the quality of life of the patient.
We accept referrals into our Functional Restoration Program from physicians, psychologists, dentists, health institutions, agencies and third-party carriers. We recommend referrals as early as possible in the course of a patient’s illness for optimal treatment success. Please contact us at 1-800-80-REHAB Ext. 308 to make a referral.
The cost of the Functional Restoration Program is minimal when compared to many years of general medical care, drugs, surgeries, diagnostic procedures, multiple hospitalizations, compensation payments and loss of work productivity, all of which are typical for chronic pain patients. Successful treatment usually pays for itself many times over.