Cilji rehabilitacije bolnikov s kronično bolečino po neuspelih operacijah na hrbtenici in z vstavljenim stimulatorjem za obvladovanje kronične bolečine z metodo draženja zadnjih stebričkov hrbtenjače
Rehabilitation goals of patients with chronic pain after failed back surgery who had a stimulator implanted for managing chronic pain using spinal cord stimulation

slovenian

2018

volume 17, supl. 1

chronic pain   Goals   goals setting   neuromodulation   Rehabilitation   vocational rehabilitation

Univerzitetni rehabilitacijski inštitut RS – Soča
(Obvezni izvod spletne publikacije)

Objectives: main goals in interdisciplinary pain rehabilitation program for patients with failed back surgery syndrome after spinal cord stimulation are directed in behavioural change to support adaptation of patients% functioning in different areas (physical functioning like walking, balance training, body mechanics, endurance, mood, quality of sleep, fatigue and participation in meaningful activities) without pain exacerbations. Skills, learned in cognitive behavioural therapy, critically support the process of behavioural change to adapt. Methods: 11 patients after spinal cord stimulation (6 male, 5 female) were included in the study. Outcome measures, routinely applied in clinical practice were used to capture possible goal fulfilment: 6 min walk test with pain assessment after walking, Berg Balance Scale, COPM, video analysis of body mechanics, Brief Pain Inventory - Pain Interference, maximal pain in the last week by numerical analogue scale and painDETECT. Results: patients after rehabilitation program progress in terms of behavioural change in different areas: they expand walking distance with less pain, improve their balance and body mechanics. Results of COPM demonstrate improvement in their self-perception of performance in everyday living. Inspite of enhanced activities the maximal possible pain remains the same throughout the rehabilitation program and symptoms of neuropathic pain component get down significantly. Brief Pain Inventory - Pain Interference demonstrates some insignificant change in less negative impact of pain on general functioning. Conclusion: in the course of the interdisciplinary pain rehabilitation program of FBSS patients after SCS the study demonstrated same measurable changes which might point to the fulfilment of goals set individually, directed generally into the behavioural change to adapt better in different areas of functioning despite remaining pain and sequel of past longterm chronic pain syndrome. Cognitive behavioural training is the key process supporting the behavioural change, which remains directly unmeasurable with currently in clinical practice valid outcome measures.

12.09.2018