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Rehabilitation Programmes to Prevent Severely Disabling Chronic Back Pain 

Rehabilitation Programmes to Prevent Severely Disabling Chronic Back Pain
Chapter:
Rehabilitation Programmes to Prevent Severely Disabling Chronic Back Pain
Author(s):

Michael K. Nicholas

and Rob J.E.M. Smeets

DOI:
10.1093/med/9780199558902.003.0163
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date: 09 May 2021

Once pain has persisted for several months and is associated with marked interference in daily activities and depressed mood, low self-efficacy, catastrophizing thoughts, and fear-avoidance beliefs, the risk is very high for continuing deterioration and reduced chances of returning to work and pre-injury lifestyles. Previous chapters in this book have clearly described the importance of identifying and helping those considered to be at risk of this secondary disability as soon as possible. But despite the best efforts of primary healthcare providers, a proportion of cases will still end up with chronic pain and many will continue to seek help. In their pursuit of help they often run the added risk of iatrogenic complications—complications caused by the treatments and attention they receive rather than the original injury. In many countries injured workers will be at increasing risk of losing their jobs the longer they are away from the workplace. They may have to deal not just with their pain and the associated activity limitations, but also with financial pressures, relationship difficulties, and the unwanted effects of multiple treatments. This chapter is directed at this group of people and their management and rehabilitation options.

Typically, the aims of rehabilitation at this stage are multiple. While pain relief is often the immediate focus of the patient, it is often unlikely to be achieved and some accommodation will have to be made to that. But other goals may well be feasible. These may be described broadly as quality of life goals, and may include return to desired work, home or social activities, as well as improved sleep, mood, and health. Some of these may initially be quite basic activities of daily living or independent functioning, like sitting long enough to achieve a task on a computer or drive to the shops. Others may be more complex, but whatever the task, the fundamental principle in all rehabilitation is that success will require the active participation of the patient suffering from pain. Rehabilitation cannot be done to someone; it can only be done with him or her. This has important implications for healthcare providers and agencies responsible for facilitating rehabilitation. It means we need to consider not just the nature of the pain but also the person in pain and his perspectives, abilities and goals (or desires), as well as the context in which he lives—the workplace, the home, even the broader social environment via the available social support systems.

In previous chapters the early identification of those at risk as well as potential contributing personal and environmental factors were described, so they will not be repeated here. Instead, we will explore the tasks likely to be involved in helping those who have slipped through the early management ‘net’ and the evidence for the interventions employed as pain persists beyond the first few months.

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