Pain Rehabilitation Center in Minnesota

PRC Patients

Patient Demographics

Approximately 400 patients are admitted to the Mayo Clinic Pain Rehabilitation Center (PRC) program every year. More females (73 percent) than males (27 percent) enter the program. The average patient age is 45 years, with the range being 12 to 84 years (although no set age criteria exists for admission to the program).

Residence: Patients come from across the United States and around the world. The majority (83 percent) of patients travel from Minnesota, Iowa and Wisconsin with fewer than half (47 percent) living in Minnesota. Approximately 6 percent of the patients are from the western United States, 6 percent from the South and 3 percent from the northeastern states. International patients account for 2 percent of the patients admitted to PRC.

Duration of pain: Typically, patients have suffered from pain for more than eight years, with a range from one month to 58 years. About half of patients have had pain for five or more years, 29 percent for 10 or more years and 11 percent have had pain for 20 years or more.

Previous interventions: Prior to coming to PRC, most patients have tried numerous pain interventions, medications and surgeries with little to no improvement in their pain and/or functioning. For example, approximately 75 percent of patients have previously participated in physical therapy, which usually focused on the site of pain. In contrast, the PRC physical therapy focuses on improving overall physical strength and endurance to regain function. Prior to admission to the PRC, physical therapy has often been provided as a stand-alone treatment rather than as part of a comprehensive program.

Completion rate: The majority (84 percent) of patients admitted to PRC complete the program.

Chronic Pain Data

Pain conditions: The PRC is fairly unique in that patients who come to the program have many types of chronic pain. Chronic back pain is the most common diagnosis, occurring in 25 percent of the patients. Fibromyalgia is also quite common, the cause of pain in 20 percent of patients. Other frequent diagnoses include chronic headache/migraines (11 percent), generalized pain or pain in multiple sites (8 percent), abdominal pain (7 percent) and neck pain (7 percent). The remaining 23 percent of patients seek treatment for pain in other sites such as the upper or lower extremities (including complex regional pain syndrome), chest wall, jaw, pelvic area, shoulders, hands, joints, knees, mouth, foot and face pain, as well as post mastectomy and neuropathic pain in cancer survivors. Nearly any site of chronic pain can be addressed in the program. Some patients with non-pain conditions that have experienced significant decline in function are also admitted to the program, including patients with chronic fatigue syndrome or postural tachycardia syndrome (POTS).

Medication tapers: Before rehabilitation, patients generally have undergone multiple pharmacological trials, including nonsteroidal anti-inflammatory drugs (NSAIDs), opioids, and adjuvant medications, as well as extensive physical therapies, interventional pain treatments, and often surgery for painful conditions. Unfortunately, chronic use of opioid analgesics or other pain medications may do little to reduce discomfort and distress due to chronic conditions or improve functioning. Some types of analgesics can be habit-forming, and most types have a potential for causing harmful effects or long-term toxicity without significant improvement in function. The elimination of analgesic medication is one goal of the PRC.

Upon admission, 45 percent of patients were taking opioid medication, 46 percent were taking nonsteroidal anti-inflammatory drugs and 17 percent were taking muscle-relaxant medication. Upon completion of the program, the majority of patients have completely tapered off of opioid analgesics and have significantly reduced their use of NSAIDs and benzodiazepines. Despite completing these tapers, patients demonstrate and report significant improvements in function and mood, as well as decreased pain severity, according to our research.

Comorbid psychological conditions: Many patients who face chronic pain also have difficulties with depression. Using the Center for Epidemiology Study-Depression scale (CES-D) to look at depressive symptoms, nearly 70 percent of the patients have depressive symptoms when entering the program. In addition, more than 42 percent of patients at admission report symptoms indicating major depressive disorder (CES-D > 27). Although depression may be a problem before the chronic pain condition developed, it is most often associated with the loss of function and sense of control patients experience with chronic pain.

Furthermore, approximately 13 percent of patients meet the criteria for an anxiety disorder. The most common anxiety disorders seen in PRC are panic disorder and post-traumatic stress disorder (PTSD). Although the anxiety disorder may have been present prior to development of the pain condition, the anxiety and pain become intertwined such that increases in one may cause increases in the other. PTSD is fairly common in patients with chronic pain, especially if the pain condition was caused by a traumatic event (e.g., motor vehicle accident, assault). In addition to assessing the presence of anxiety disorders, PRC psychologists provide cognitive-behavioral treatment for panic disorder and/or assist in identifying a therapist trained in cognitive behavioral therapy close to the patient's home for ongoing assistance.

See Treatment Outcomes for more information about specific outcomes.

Making the Decision to Participate in the PRC Program

Pain rehabilitation is challenging and requires a serious commitment. Those considering admission to the Pain Rehabilitation Center should ask themselves these questions:

• Is my life focused on pain and what I am not able to do, rather than what I am able to do in spite of the pain?
• Are my doctors telling me there is nothing further they can do to relieve the pain? Do they tell me that I need to learn to get on with my life?
• Am I truly concerned about the long-term effects of taking pain medications?
• Is my family's well-being affected by my chronic pain?
• Is my recovery from injury or illness taking much longer than my doctors or I expected?
• Am I not able to commit to social events with family or friends because my pain may be higher that day?

When the answer to one or more of these questions is "Yes," the PRC may be appropriate.

Criteria for Admission

The decision to participate in the rehabilitation center program is complex. The staff want all patients to succeed in reaching their goals and experience improved physical and emotional functioning. During a pre-admittance evaluation by the staff, aspects of physical, emotional and cognitive function will be assessed. The following criteria are used to evaluate suitability for the rehabilitation program:

Inclusion criteria

• Chronic pain of sufficient severity to bring about significant dysfunction in daily social, vocational, and interpersonal activities
• Chronic pain duration of six months or more or clinical indication that pain of a shorter duration will likely manifest into a chronic condition
• Adequate control over behavior and not judged to be imminently dangerous to self or others
• Demonstration of adequate motivation to proceed with a rehabilitation approach to management of pain, which often implies awareness or some level of acceptance that medical or surgical treatments are not a present option

Exclusion criteria

• Unwillingness to discontinue use of narcotic medications, other psychotropic medications, or substances of abuse as recommended that would preclude meaningful participation in the program
• Insufficient motivation to address the necessary components that make up the general scope of pain rehabilitation, including medication management, physical and occupational therapy, and group therapy
• An acute physical condition or illness exists and is currently being treated in a manner that would preclude adequate participation in the program