Chronic pain is a debilitating condition that affects people all over the world. In the North America, the prevalence of chronic pain is estimated at 30.7%, and spine and musculoskeletal disorders account for nearly 70 million physician office visits annually and 130 million outpatient, hospital, and emergency room visits. For persons under the age of 45, low back pain is the leading cause of disability. Back-related disabilities are also the most prevalent cause of disability in the military. To reduce treatment costs, as well as disability and absenteeism from work, acute pain cases (less than 6 weeks in duration) must be prevented from becoming chronic pain cases (more than 3 months in duration).

To address this challenge, the functional restoration treatment approach was developed in the 1980s in the United States. Economic aspects of chronic pain care were consequently addressed by a few studies. Gatchel et al clearly demonstrated the cost effectiveness of an early multidisciplinary intervention in acute low back pain patients who were identified as having a high risk for chronicity. Schweikert et al found that the cost of adding cognitive behavioral treatment to standard therapy was largely offset by lower indirect costs.

Evidence-based, novel, and cost-effective care pathways can be used to quickly and effectively triage the target-patient population at a central entry point. Treatment plans focus on a cross-disciplinary and multimodal approach to pain control utilizing evidence-based medical therapy, as well as on functional restoration and multidisciplinary pain rehabilitation programs that have been proven effective. Given the large population of patients affected by chronic back pain and the high and rapidly rising cost of treatment, comprehensive and multimodality delivery models are imperative for efficient triage, functional restoration, and pain rehabilitation.

One of the main goals of a Chronic Pain Rehabilitation Program is to wean patients off opiates so they avoid the short- and long-term side effects of chronic opioid management. The well-known side effects of opioids are nausea, sedation, euphoria or dysphoria, constipation, and itching. With chronic use of opioids, most side effects subside, as patient tolerance to side effects seems to be greater than tolerance to analgesic effects.

Sources Cited:
Johannes CB, Le TK, Zhou X, Johnston JA, Dworkin RH. The prevalence of chronic pain in United States adults: results of an Internet-based survey. J Pain. 2010 Nov;11(11):1230–1239.
Gatchel RJ, Polatin PB, Noe C, Gardea M, Pulliam C, Thompson J. Treatment- and cost-effectiveness of early intervention for acute low-back pain patients: a one-year prospective study. J Occup Rehabil. 2003 Mar;13(1):1–9.
Schweikert B, Jacobi E, Seitz R, et al. Effectiveness and cost-effectiveness of adding a cognitive behavioral treatment to the rehabilitation of chronic low back pain. J Rheumatol. 2006 Dec;33(12):2519–2526.