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Chronic pain has been defined by Turk1,2 as a function of a complex interaction among demographic, physical, psychological, social, and economic factors, including age, sex, education, medical status, pain severity, alcohol and substance abuse, beliefs about pain, increased used of medications and of health care services, and a generalized adoption of the sick role. Because chronic pain is multifactorial in nature, the use of any one modality, pharmacologic treatment, alternative medicine, or psychologic approach is bound to fail. Pain management in an inpatient center provides a model of interdisciplinary treatment consisting of medical care, medication management, physical reconditioning, training in body mechanics, meditation, relaxation, biofeedback psychology, and milieu therapy. Patients who are referred to an inpatient chronic pain program commonly experience functional disabilities, social dysfunction, narcotic and alcohol dependency, child abuse history, vocational impairment, dependency on the public welfare system and the workmen’s compensation system, and significant psychiatric disorders that are both antecedent to and consequent from chronic pain. Therefore, the objectives, treatment procedures, outcome measures, and long-term success of inpatient chronic pain management are distinct from treatment of acute pain, malignant pain, and postoperative pain.

The objectives of pain management are manifold. The first objective is to assist the patient in developing coping mechanisms for chronic pain. Patients who have been referred to inpatient programs have failed to adapt to their pain despite numerous treatments that have been given in the community. Upon evaluation, these patients report a history of numerous visits to emergency departments, pain blocks, narcotics, and other standard medical procedures that have failed to provide them with pain relief. The clinician must convince the patient that all standard medical treatments have been offered and given. The task of the patient is to learn coping mechanisms in order that pain no longer is prepotent in their lives.

The second objective is to develop the maximum potential of the patient for normal living, which includes physical, social, psychological-spiritual, and vocational rehabilitation. For too many years, pain management was separated from rehabilitation. When pain management is conducted in isolation from other rehabilitation programs, it focuses on the narrow problems of narcotic addiction and depression. Pain patients, however, have potential for return to work, school, homemaking, and volunteer activities in the community. By keeping the objective on rehabilitation, the focus is changed from a narrow goal of reducing drug dependency to a broader goal of preparation for or return to normal living in the community.3

The third objective is to provide functional restoration for patients who have been deconditioned over several months and years. Functional restoration includes physical function, such as walking, stair climbing, standing, balancing, sitting, and endurance in performance of strenuous activities at work or at home. Although few studies have documented the improvement in physical function in pain management centers, Harding and associates4 showed significant improvement in measures such as a 10-minute walking test and a 20-minute speed walk. One ...

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