Evidence based rehabilitation in chronic pain syndromes

Abstract

Chronic pain syndrome (CPS) is complex and involves multiple factors, but should be considered if a person does not respond to appropriate medical care within a reasonable time frame or if the person's pain behavior greatly exceeds the usual response to a specific disorder. There are many chronic pain syndromes but fibromyalgia syndrome (FS), chronic fatigue syndrome (CFS) and myofascial pain syndrome (MPS) are the most common ones. These are the common problems that the CPS patients typically have; such as reduced activity, sleep disturbance, depression, suicide attempts, social withdrawal, irritability and fatigue, strong somatic focus, memory problems, cognitive impairment, less interest in sex. These are the others: Relationship problems, medication abuse, helplessness, hopelessness, alcohol abuse, guilt conscience, anxiety, poor self-esteem, loss of employment, and finally «kinesiophobia». Each patient can be unique in the distribution of these problems. The goals of pain rehabilitation are: Improvement of physical function and prevention further loss Increase functional independence Maintain quality of life for individuals living with CPS Improvement of vocational/disability status Reduction/discontinuation of opiate and sedative-hypnotic medications Reduction of healthcare utilization for the CPS Reduction of pain level Providing the person highest possible level of function can only be possible with rehabilitation team approach. Phsical therapy has a wide variety of techniques, ranging from soft tissue massage to acupressure, to help restore and improve flexibility of muscles, tendons, and joints, also uses various techniques for soft tissue healing, such as hydrotherapy, electrical stimulation, application of cold or heat through the use of shortwave diathermy, microwave diathermy, and ultrasound. Therapeutic exercise is an important part of physical therapy, helping to stretch and strengthen muscles weakened by disease and injury. Relaxation therapy is beneficial to reduce anxiety, autonomic hyperactivity, and muscle tension, all seen in chronic pain states. Techniques such as imagery, progressive muscle relaxation, controlled breathing, or listening to relaxation tapes are commonly used in programs designed to manage CPS. Manual therapy is defined as a clinical approach utilizing skilled, specific hands-on techniques, including but not limited to manipulation/mobilization, increasing range of motion (ROM), reducing or eliminating soft tissue inflammation, inducing relaxation, improving contractile and non-contractile tissue repair, extensibility and/or stability, facilitating movement and improving function. Also biofeedback, occupational therapy, psychotherapy and cognitive therapy are useful in treatment of CPS. In conclusion, there are some basic principles on evidence based rehabilitation on CPSs. In recent years point of view in chronic pain rehabilitation changed substantially. Physical modalities seem to loose their importance. However, therapeutic exercises, aerobic physical activities are in the most recommended preferences. Pharmacotherapy is not sufficient alone. Finally, treatmet programmes should be planned individually and should be modified if necessary.