Multi-disciplimary Spinal Rehabilitation Programme for Chronic Back Pain (Starting in Spring 2016)
For patients with chronic back pain, the National Institute of Clinical Excellence (NICE) recommends treatment with a multi-disciplinary spinal rehabilitation programme. This has been proven in many scientific studies to be an effective treatment for chronic low back pain.
What does the programme involve?
The programme is run for groups of patients at a time. The first part of the program consists of Education on:
- Spinal Anatomy and structure
- The way the spine functions
- Mechanics of the spine
- Role of spinal muscles
- Disc degeneration
- What causes pain, and the natural pain cycle
- The effect of pain on our mood, and the effect of our mood on pain
- The importance of movement and exercise
- Pain management strategies and coping mechanisms
- Role of medication in pain management
- Importance of a good diet
- Good posture and how to lift and sit properly
- The importance of sleep
The second part of the program is Exercise:
- A floor based core stability program. This involved strengthening the muscles around the spine, including the stomach muscles, the muscles at the back and sides
- An aerobic fitness program- this results in the release of chemicals called endorphins which are the body’s natural pain killers
The third part of the program is Psychotherapy, to explore the links between pain and mood and teach patients effective techniques to deal with the pain.
- Education about the link between pain and mood
- Cognitive Behavioural Therapy (CBT), which is an effective technique of managing the psychological distress associated with pain
Who runs the programme?
- The program is headed up by a spinal surgeon who is available to answer questions
- Day to day management is done by a physiotherapist
- There is a sports therapist or Pilates instructor who runs the exercise classes
- A counsellor/psychotherapist
How long does the programme run for?
- It’s typically run over 4 weeks
- There are 2 hour sessions, 4 times a week
- After 4 weeks, maintenance exercise classes are available but have to be paid for separately.
What should patients expect from the programme?
All the research suggests that at the end of the program patients should expect:
- To have less pain, but not necessarily pain free
- To be using less medication
- To be functionally more active
- To be able to manage the pain better
- To be less psychologically distressed by the pain
As with all medical interventions there is a degree of uncertainty involved and benefits cannot be guaranteed. Some patients experience a flare of pain, which usually resolves with medication and a short period of rest. Patients are then encouraged to keep going with the programme.
Some patients may experience no benefit from the programme and uncommonly, some may say they are worse off.
Not all patients are suitable for inclusion in the programme, and there will be an initial assessment where this will be decided.
Is this programme an alternative to surgery?
Many patients improve to the point where they no longer need surgery. The programme is therefore a cost-effective and safer alternative to spinal surgery in most patients with chronic low back pain.
What happens after the programme?
Patients are expected to continue with the exercise programme they have been taught and will need to follow the maintenance exercise routine 3-4 times a week, in addition to incorporating the other messages they take home from the program.