PHYSICAL LIMITATIONS ARE NOT REQUIRED FOR CHRONIC PAIN REHABILITATIONSUCCESS

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.