Evaluation of a Functional Restoration Program at Fort Bliss Interdisciplinary Pain Management Clinic

Abstract

Introduction: In partnership with the Veterans Health Administration, in 2010, the Department of Defense/Veterans Health Administration Pain Management Task Force Final Report recommended a comprehensive pain management plan. Consequently, each Army medical center established an Interdisciplinary Pain Management Clinic (IPMC) for pain treatment, and each IPMC implements a multidisciplinary outpatient functional restoration program (FRP) as an alternative to or in addition to pharmacological therapy. This article reports our first-year FRP results at William Beaumont Army Medical Center IPMC. Materials and Methods: The FRP is designed to improve the participants' functionality and quality of life, both personally and professionally. Service members with chronic pain were evaluated for psychological and physical clearance before enrollment in an intense and structured FRP for 8 hours a day over 3 weeks. The program focused on physical and occupational exercises, yoga, acupuncture, and educational classes regarding pain medications, nutrition, and coping skills. The resulting data were analyzed using paired two-tailed t-tests with a predetermined significance level of 0.05 to examine the participants' mean changes upon completion of the FRP. Results: The pre-post comparison indicated significant improvement after completion of the FRP. The fear-avoidance of physical activities and the fear of movement scores were reduced significantly (P < 0.05); the Canadian occupational performance and satisfaction, physical strength and endurance were improved significantly (P < 0.0001) in sit-to-stand, plank balance, lifting and carrying, and 10-minute 7-to-1 Pyramid tests; however, fear-avoidance of work was not significantly reduced (P = 0.2319). Conclusions: Because of the lack of randomization and the small number of subjects (N = 32, 7 cohorts), unknown sources of bias may have influenced the results. Despite these limitations, the results from this report support the program's effectiveness and are consistent with the outcomes from FRP programs in other military facilities and in civilian studies.