S-3-07-02
PAIN REHABILITATION: A MULTIDISCIPLINARY APPROACH
Sae-II Chun, M.D. (Yonsei University College of Medicine, Seoul, Korea)
Pain is one of the most commonly encountered clinical entities in rehabilitation medicine for management of which physiatrists should be almost always equipped. Pain syndromes usually dealt in rehabilitation medicine are chronic in nature. Different from acute pain, a chronic pain contains such complexity as intensity, frequency, duration, and relationship with activities, medications, emotional status etc. which must be taken into consideration in evaluation and treatment, Pain contains nociception as physiologic factor, pain symptom as a clinical factor, pain suffering as personal factor, and pain behavior as social factor. Since the characteristics of rehabilitation medicine are function-oriented, comprehensive, and team approach, rehabilitative handling of pain is that the concept of therapy should be management instead of treatment, therapeutic outcome should be more focussed on functional gain rather than symptomatic relief, extent of therapy must cover personal, familial, social and vocational aspects, and that the method of therapeutic approach must be with not only multidisciplinary but also multimodality one. For a successful program of chronic pain management, various specialists and modalities of drugs, injections, surgery, psychology, physical therapy, occupational therapy, orthosis, and others should be participated.
S-3-07-03
Pain Management in Japan
Tetsumi Honda MD (Tokyo Metropolitan Rehabilitation Hospital, Tokyo)
Chronic non-malignant muskloskeletal pain is one of the major problems encountered in rehabilitation medicine. Many therapeutic approaches including medication, nerve block, surgery, and physical modalities (heat therapy, TENS, acpuncture, massage, etc.) proved not to be sufficiently effective for this condition.
I started a multidisciplinary pain management program based on cognitive- behavioral therapy in 1988. To date, forty-eight patients who have participated in this program showed (1) decreased subjective sensation of pain, (2) increased physical activities, and (3) improved depressed mood. The factors contributing to these changes will be discussed. In addition, I will comment upon some psychological characteristics of chronic pain patients in Japan. In terms of the Japanese version of the Illness Behaviour Questionnaire of Honda et al (1995), the overall profiles of chronic pain patients is rather similar to that of patients with affective disordes, although there seems to be a heterogenesity in the psychological characteristics of chronic pain patients.
