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Pain Intensity As a Predictor of Rehab Outcomes

Posted on: 03/29/2006
Pain as a result of a work-related injury is a good predictor of the final outcome. Will the person be able to get back to work? Will he or she finish the rehab program? According to this study, the level of pain before rehab is a good way to predict the final result after rehab.

Over 3,000 patients with chronic pain from work-related musculoskeletal disorders were included in this study. The Visual Analog Scale (VAS) was used to measure pain levels. The VAS is a straight line with zero meaning 'no pain' at one end and 10 or 'extreme pain' at the other end. The patient makes a mark anywhere along the line to show the level of his or her pain.

Patients were grouped together as 'mild,' 'moderate,' or 'severe' according to their VAS scores. Everyone went through a rehab program of exercise, counseling, and fitness. Stress management was also included. One year later each patient was contacted by phone to assess outcomes. The authors report the following findings:

  • Patients with extreme pain levels before rehab are less likely to finish rehab.
  • Surgery was 11 times more likely in patients with extreme pain after rehab.
  • Post rehab surgery increases the risk of disability and loss of work status.
  • Patients with extreme pain after rehab were four times less likely to go back to work.
  • Disability increases as pain level increases.

    The results of this study suggest a need for better case management for patients with extreme pain before rehab. Counseling, patient education, and close supervision during rehab may give better results in high-risk patients. The authors suggest surgeons think twice before operating on chronic pain patients. Anyone with extreme pain ratings is at risk for worse outcomes after surgery.

  • References:
    Donald D. McGeary, PhD, et al. High Pain Ratings Predict Treatment Failure in Chronic Musculoskeletal Disorders. In The Journal of Bone and Joint Surgery. February 2006. Vol. 88-A. No. 2. Pp. 317-325.

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