Jc. King et al., PHYSICAL LIMITATIONS ARE NOT REQUIRED FOR CHRONIC PAIN REHABILITATIONSUCCESS, American journal of physical medicine & rehabilitation, 73(5), 1994, pp. 331-337
A high performance, active duty fitness requirement group rehabilitate
d equally to a low performance needs civilian group, both suffering fr
om disabling chronic pain. The purpose of this prospective study was t
o determine whether higher physical performance requirements adversely
affected outcome in a chronic pain rehabilitation program. Twenty-thr
ee active duty, chronic pain patients were treated along with 22 civil
ian chronic pain sufferers in a behavior modification, including posit
ive, verbal reinforcement for performance, stress management and famil
y counseling, physical reconditioning, including stretching, strengthe
ning and aerobic conditioning in a slowly progressive fashion to requi
red needs, and narcotic and muscle relaxant detoxification program at
a major military medical center, Eighteen patients in each group, repr
esenting, respectively, 78 and 82% of the military and civilian partic
ipants, successfully completed the inpatient program. Success was defi
ned by (1) elimination of all narcotics and minor tranquilizers, (2) e
limination of all physical restrictions that precluded any desired wor
k or play, which required much higher levels for the active duty patie
nts that included: (3) elimination of all physical profile restriction
s and (4) objectively passing annual aerobics field test requirements
before the program's end. Review of military disability separation rec
ords, averaging 24 mo posttreatment, showed that no formerly successfu
l active duty patients had later been discharged because of physical i
mpairments. Of individuals responding to mail questionnaires at an ave
rage of 19 mo postprogram, 12 of 14 (86%) initially successful militar
y patients reported continued unrestricted maintenance of physical abi
lities, whereas 10 of 14 (71%) of the initially successful civilians r
eported no restrictions in desired activities. In both the active duty
and civilian chronic pain patients, regardless of the degree of physi
cal requirements, 80% were rehabilitated to their required levels of p
erformance to eliminate all disability, with reasonable attrition over
time; This data suggest that arbitrary physical limitations often may
not be necessary. Such restriction may better define a lack of adequa
te rehabilitation than physiologic limitations for most chronic pain p
atients.