Chronic Pain Rehabilitation Program
Understanding chronic pain.
The Chronic Pain Rehabilitation Program at the Cleveland Clinic was started in 1979 and has helped more than 6,000 people since then. Chronic pain affects millions of Americans, many of whom have tried multiple treatments without relief. Pain can interfere with a person’s ability to work, participate in social and recreational activities, and may affect relationships with family or friends. Over time people may restrict their activities, which in turn, causes them to become less physically fit to the point that even minor activities cause increased pain.
Research over the last 30 years has shown that acute pain, for example that associated with injury, illness, or surgery, is mostly due to changes in injured tissues. Chronic pain, in contrast, is mostly due to changes in the nervous system. These changes increase its sensitivity to the point that even harmless stimulation may be painful. While the pain that people experience is mostly a result of these neurological changes, the changes in function and quality of life are more determined by general health/fitness and psychological factors. The same is true of overall suffering. Therefore the Chronic Pain Rehabilitation Program (CPRP) focuses primarily on reconditioning and psychological coping strategies to ensure that chronic pain does not take over a person’s life. When it has already done so, the goal is to restore the person to their maximum level of comfort and function.
Treatment in the CPCP is provided by a team of physicians, nurses, psychologists, counselors, physical therapists and occupational therapists. By combining several disciplines, we are able to deliver comprehensive care that targets the multiple needs of those with chronic pain. Pain physicians manage the medical care of each patient, including medications and weaning from habituating medications when indicated. Physical and occupational therapists help patients regain strength, endurance, and flexibility. Psychologists and counselors help patients understand, identify and change thoughts and feelings that can increase pain and stress. Relaxation training, meditation and biofeedback assisted therapy are used to help patients learn to regulate the stress response that increases pain and suffering. Education for the patient and family is a central focus of the program and is provided by several disciplines.
In 2012, The American Pain Society designated Cleveland Clinic's Chronic Pain Rehabilitation Program as a Clinical Center of Excellence. These awards are given annually and recognize pain-care teams that “overcome difficult challenges to provide outstanding, exemplary care” for those with pain conditions.
About the program
Pain from an injury or disease usually subsides following medical care or disappears spontaneously. But for 40 million Americans, there is no relief from the pain, according to the National Institutes of Health. This type of pain is unresponsive to conventional treatments. Living with chronic pain requires a change in mindset so that the pain doesn’t evolve into a disability affecting daily activities, attitudes and relationships. The CPCP addresses these issues with a multi-disciplinary team skilled in managing chronic pain.
What does the Chronic Pain Rehabilitation Program involve?
The CPRP is an all-day program with active treatment from 7:30 a.m. – 5:00 p.m. Monday through Friday. Evenings are spent at home or at other available lodging.
We create an individualized plan for each person. However, general components of the program include the following:
- Treatment directed by pain management physicians, nurses and therapists
- Daily physical and occupational therapy exercise classes and individual sessions as appropriate
- Medication management (typically weaning unhelpful medications and trials of non-addicting medications for chronic pain)
- Biofeedback training
- Cognitive behavioral therapy
- Psychotherapies to improve coping, and reduce the anxiety and depression that can result from pain and disability
- Vocational rehabilitation
- Chemical dependency education if indicated
- Family education and counseling
- Relaxation training
- Tai chi
How long does the Chronic Pain Rehabilitation Program take?
Most people who are seriously disabled and suffering from chronic pain require 3-4 weeks to be able to function well and begin to feel joyous and productive. Some people are doing well and complete the program in 2 weeks, while others may require more than 4 weeks to achieve their goals. Of course, this is only a start, and working to maintain wellness will need to become a way of life for benefit to endure.
After completing the program, patients are encouraged to continue with the Section of Pain Medicine’s follow-up services. Aftercare programs include free monthly relapse prevention and coping skills groups. CPRP graduates can also schedule office visits for medication management during aftercare programming days.
The Section of Pain Medicine also offers outpatient management of chronic pain for those who do not need an intensive rehabilitation program. Our medical providers provide consultation for a variety of conditions and provide input on diagnoses, medication and alternative treatment recommendations. Our pain psychologists offer consultations for consideration of biofeedback assisted pain and stress management, cognitive behavioral therapy for pain or for outpatient group therapy. We have a number of specialty clinics for a variety of pain conditions including fibromyalgia, abdominal pain and a comprehensive spine clinic.
What should you hope for?
Every person with chronic pain wants it to go away. Unfortunately, chronic pain is generally not curable, although television and the Internet are full of ads suggesting otherwise. Many find it hard to visualize having a life that is both fun and productive in the presence of chronic pain; however, our patients do it every day. People commonly arrive depressed, in severe pain, confined to wheelchairs and walkers, and are surprised to find themselves laughing and playing volleyball in the pool after only a few weeks. Although most patients experience a reduction in pain, our most important goal is to help restore your quality of life.