Gain in functions before pain reduction during intensive multidisciplinary paediatric pain rehabilitation programme

In this issue of the Scandinavian Journal of Pain Heidi Kempert and co-workers report on their study of 78 children and adolescents (8–19 years) who took part in an intensive interdisciplinary pain rehabilitation programme with focus on gain in function rather than reduction of pain [1]. Headache/migraine, complex regional pain syndrome (CRPS), amplified musculoskeletal pain syndrome (AMPS), back pain, and abdominal pain were the most common diagnoses. The 3 weeks intensive multidisciplinary pain rehabilitation programme focused on improving strength and endurance, facilitating return to daily activities, and appropriate coping and pain management skills. They measure progress by improved physical functioning, even if pain and other symptoms continue without much immediate change.

Physical and occupational therapies were administered during 3–4 h daily, with individualized muscle strengthening and endurance, proprioceptive and sensory training. Parents were included and trained to assist in continuing appropriate activities at home.

Results at end of the programme were compared with baseline measurements. Self-evaluation with validated scales for upper and lower extremities was used during the programme. Objective measures were number of push-ups, crunches, prone extension, step ups, and jump rope repetitions during 60 s. These were measured weekly with the patients self-counting numbers of repetitions. Pain was recorded as pain severity in last 24 h using a 0–10 numeric rating scale [1,2].

These relatively simple assessments of gain in functions clearly show that the multidisciplinary pain rehabilitation programme at the Cleveland Clinic Children’s Hospital for Rehabilitation definitely improve physical functions as measured objectively and as assessed by the patients themselves.

A moderate reduction in pain severity in last 24 h from NRS 6.7/10 at baseline to 5.5/10 at discharge after 3 weeks is not impressive, but was as expected by the authors. The striking gain in functions as evident from self-reports and the objective measures of the 5 exercises, indicate that patients understand and realize that gain in function comes before reduction of pain. The planned continuation of individualized activities at home is expected to maintain and continue the improvement in daily functioning and age related appropriate activities, improving the patients’ quality of life, ability to cope and tolerate remaining pain [1].