Industrial Rehabilitation: Chronic Pain/Fibromyalgia Treatment Program

This is a multidisciplinary, biopsychosocial, wellness-based, functional restoration, pain-management program to treat central sensitization, which is the prime perpetuating factor in fibromyalgia and myofascial pain syndrome.

This program is described as non-pharmacologic. Certain drugs prevent the patient from fully participating in or benefiting from a behavioral pain program. Behavioral therapy is impossible to teach to: (1) patients with pain if they are taking analgesics, (2) patients with sleep problems if they are taking sleeping pills or drugs that disturb sleep, (3) patients with fatigue issues if they are on drugs that cause fatigue or cause excess stimulation. Generally these are analgesics (opioid and non-opioid), hypnotics, tricyclic antidepressants (which increase daytime fatigue and impair cognition), neuroleptis, (often cause fatigue) and muscle relaxants (generally ineffective and cause fatigue).

This program is evidence-based and documented with standardized outcome assessments and a system for symptom rating. It meets all of the standards for chronic pain management in the Medical Treatment Utilization Schedule (M-TUS) and ACOEM Practice Guidelines. It is also supported by the National Guidelines for Chronic non-malignant pain syndrome patients II: An evidence–based approach (www.guideline.gov).

Click here for a detailed description of our Full Industrial Rehabilitation Program.

Medication Management for a Biopsychosocial Pain/Fatigue Management Program

Almost all the patients referred to my program are on a drug-management plan that is appropriate for medical management of pain in the absence of a behavioral program. But behavioral pain-management is so effective that it adds a new dimension to the management of chronic pain. It requires a separate approach to medical management. This program provides the combination of behavioral sleep retraining with behavioral management of pain, mood, and fatigue. All of this is tailored specifically for patients with fibromyalgia syndrome or myofascial pain syndrome. Although this program is considered behavioral, it is not based on psychological theory; instead it is built upon principles of neurophysiology and behavioral-change theory.

This program offers both: (1) behavioral management for pain and mood and (2) behavioral retraining for sleep. These are viable options for reducing symptoms and improving quality of life for people with sleep disorders, chronic pain, depression, and central sensitization. The average patient with severe problems experiences a 40-50% reduction in symptoms in about twelve weeks. But this outcome often requires the treating physicians and psychiatrists to reevaluate or redesign their medication plans so that drug management is not only supportive of a behavioral pain-and-sleep program but integrates this behavioral intervention into their overall approach with the patient. This program expands the options for the treating physician.

The patient does not have to be off of all drugs to start this program. The program is designed to support the patient in the withdrawal process and eliminate the need for non-essential drugs or drugs that prevent wellness.

Click here for a detailed description of Medication Issues and Behavioral Treatment.