Interdisciplinary Functional Restoration and Pain Programs

  • Steven D. Feinberg
  • Robert J. Gatchel
  • Steven Stanos
  • Rachel Feinberg
  • Valerie Johnson-Montieth


The major purpose of the present chapter is to provide a review of the currently most therapeutically effective method for managing chronic pain—functional restoration (FR). Before doing so, a brief overview of the rehabilitation process will be provided. Indeed, throughout history, the treatment of chronic pain conditions has been difficult, time consuming, expensive, and, all too often, unsuccessful. Many modes of treatment, both invasive (injections, procedures, surgery, etc.) and noninvasive methods (medications, physical therapy, counseling, applications of heat, ice, transcutaneous electrical stimulation, and many others), have been used by the health-care profession in an attempt to eliminate pain and return these patients to a productive, fulfilling life.


Chronic Pain Cognitive Behavioral Therapy Chronic Pain Patient Chronic Pain Condition Biopsychosocial Model 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


  1. 1.
    Andersson GBJ, Cocchiarella L, editors. The AMA guides to the evaluation of permanent impairment. 5th ed. Chicago: American Medical Association; 2000.Google Scholar
  2. 2.
    The AMA guides to the evaluation of permanent impairment. 6th ed. Chicago: American Medical Association; 2007.Google Scholar
  3. 3.
    The American Physical Therapy Association. Guide to physical therapist practice. Second edition. American Physical Therapy Association. Phys Ther. 2001;81(1):729–38.Google Scholar
  4. 4.
    International Classification of Functioning, Disability and Health (ICF).
  5. 5.
    Foley BS, Buschbacher RM. Occupational rehabilitation. In: Braddom RL, editor. Physical medicine and rehabilitation. 3rd ed. Philadelphia: Saunders/Elsevier; 2007. p. 1047–54.Google Scholar
  6. 6.
    Zimmerman M. The history of pain concepts and treatment before IASP. In: Merskey H, Loeser J, Dubner R, editors. The paths of pain. Seattle: IASP Press; 1975–2005.Google Scholar
  7. 7.
    Engle GL. The need for a new medical model: a challenge for biomedicine. Science (New Series). 1977;196(4286):129–36.CrossRefGoogle Scholar
  8. 8.
    Engel GL. Psychogenic pain and pain-prone patient. Am J Med. 1959;26:899–918.PubMedCrossRefGoogle Scholar
  9. 9.
    Turk DC, Monarch ES. Biopsychosocial perspective on chronic pain. In: Turk DC, Gatchel RJ, editors. Psychological approaches to pain management: a practitioner’s handbook. 2nd ed. New York: Guilford; 2002. p. 3–29.Google Scholar
  10. 10.
    Gatchel RJ, Bruga D. Multi- and interdisciplinary intervention for injured workers with chronic low back pain: invited review. SpineLine. 2005.
  11. 11.
    Murphy WB, editor. Healing the generations: a history of physical therapy and the American Physical Therapy Association. Alexandria: American Physical Therapy Association; 1995.Google Scholar
  12. 12.
    Bonica JJ. Organization and function of a pain clinic. Northwest Med. 1950;49:593–6.PubMedGoogle Scholar
  13. 13.
    Turk DC. Biopsychosocial perspective on chronic pain. In: Gatchel RJ, Turk DC, editors. Psychological approaches to pain management: a practitioner’s handbook. New York: Guilford Press; 1996. p. 33–52.Google Scholar
  14. 14.
    Brena SF. Pain control facilities: patterns of operation and problems of organization in the USA. Clin Anesth. 1985;3:183–95.Google Scholar
  15. 15.
    Sullivan MJ. Toward a biopsychomotor conceptualization of pain. Clin J Pain. 2008;24:281–90.PubMedCrossRefGoogle Scholar
  16. 16.
    Gatchel RJ, Polatin PB, Noe CE, Gardea MA, Pulliam C, Thompson J. Treatment and cost-effectiveness of early intervention for acute low back pain patients: a one-year prospective study. J Occup Rehabil. 2003;13:1–9.PubMedCrossRefGoogle Scholar
  17. 17.
    Gatchel R, Okifiji A. Evidence-based scientific data documenting the treatment and cost-effectiveness of comprehensive pain programs for chronic nonmalignant pain. Pain. 2006;7(11):779–93.CrossRefGoogle Scholar
  18. 18.
    Flor H, Fyfrich T, Turk DC. Efficacy of multidisciplinary pain treatment centers: a meta-analytic review. Pain. 1992;49(2):221–30.PubMedCrossRefGoogle Scholar
  19. 19.
    Guzman E. Multidisciplinary rehabilitation for chronic low back pain: systematic review. BMJ. 2001;322:1511–6.PubMedCrossRefGoogle Scholar
  20. 20.
    Curry R. Understanding patients with chronic pain in work hardening programs. Work programs special interest section newsletter (American Occupational Therapy Association). 1989;3:3.Google Scholar
  21. 21.
    Wegg L. Essentials of work evaluation. Am J Occup Ther. 1960;14:65–9.PubMedGoogle Scholar
  22. 22.
    Chou R, Loeser JD, Owens DK, Rosenquist RW, Atlas SJ, Baisden J, Carragee EJ, Grabois M, Murphy DR, Resnick DK, Stanos SP, Shaffer WO, Wall EM, American Pain Society Low Back Pain Guideline Panel. Interventional therapies, surgery, and interdisciplinary rehabilitation for low back pain: an evidence-based clinical practice guideline from the American Pain Society. Spine. 2009;34(10):1066–77. doi: 10.1097/BRS.0b013e3181a1390d.PubMedCrossRefGoogle Scholar
  23. 23.
    American College of Occupational and Environmental Medicine. Occupational medicine practice guidelines, chronic pain chapter update. Beverly Farms: Occupational and Environmental Medicine Press; 2008.Google Scholar
  24. 24.
    Feinberg SD, Feinberg RM, Gatchel RJ. Functional restoration and chronic pain management. Crit Rev Phys Rehabil Med. 2008;20(3):221–35. doi: 10.1615/CritRevPhysRehabilMed.v20.i3.30.CrossRefGoogle Scholar
  25. 25.
    Gatchel RG, Mayer TG, Hazard RG, et al. Editorial: functional restoration. Pitfalls in evaluating efficacy. Spine. 1992;17:988–94.PubMedCrossRefGoogle Scholar
  26. 26.
    Turks DC, Swanson K. Efficacy and cost effectiveness treatment of chronic pain: AN analysis and evidence –based synthesis. In: Schatman MF, Campbell A, editors. Chronic pain management guidelines for multidisciplinary program development. New York: Informa Healthcare; 2007. p. 15–38.Google Scholar
  27. 27.
    Siddall PJ, Cousins MJ. Persistent pain: a disease entity. J Pain Manag. 2007;33 suppl 2:s4–10.Google Scholar
  28. 28.
    Crombez G, Vlaeyen W, Heuts P, et al. Pain related fear is more disabling than pain itself: evidence on the role of pain-related fear in chronic back pain disability. Pain. 2005;80:329–39.CrossRefGoogle Scholar
  29. 29.
    Vlaeyen J, Linton S. Fear-avoidance and its consequences in chronic musculoskeletal pain: a state of the art. Pain. 2000;85:17–32.CrossRefGoogle Scholar
  30. 30.
    de Jong JR, Johan WS, Vlayen JWS, Onghena P, Goossens MEJB, Geilen M, Mulder H. Fear of movement/ (re)injury in chronic back pain education or exposure in vivo as mediator to fear reduction? Clin J Pain. 2005;21:9–17.PubMedCrossRefGoogle Scholar
  31. 31.
    Jelinek S, Germes D, Leyckes N. The Photograph series of Daily Activities (PHODA); lower extremities [CD-ROM]. The Netherlands: Hogeschool Zuyd, University Maastricht and Institute for Rehabilitation Research; 2003 (iRv).Google Scholar
  32. 32.
    Harden N, Cohen M. Unmet needs in the management of neuropathic pain. J Pain Symptom Manage. 2003;25(5 Suppl 1):s12–7.PubMedCrossRefGoogle Scholar
  33. 33.
    Bruel S, Chung OY. Psychological and behavioral aspects of complex regional pain syndrome management. Clin J Pain. 2006;22(5):430–7.CrossRefGoogle Scholar
  34. 34.
    Gatchel R, Rollings K. Evidence-informed management of chronic low back pain with cognitive behavioral therapy. Spine J. 2008;8:40–5.PubMedCrossRefGoogle Scholar
  35. 35.
    McBerth J, Macfarfane G, Bejnamin S, et al. The association between tender points, psychological distress, and adverse childhood experiences: a community-based study. Arthritis Rheum. 1999;42:1397–404.CrossRefGoogle Scholar
  36. 36.
    Wheeler A. Myofascial pain disorders: theory to therapy. Drugs. 2004;64:45–62.PubMedCrossRefGoogle Scholar
  37. 37.
    Sanjsjo I, Melin B, Rissen D, et al. Trapezius muscle activity, neck, and shoulder pain, and subjective experiences during monotonous work in women. Eur J Appl Physiol. 2000;83:235–8.CrossRefGoogle Scholar
  38. 38.
    Mork P, Westergaard R. Low-amplitude trapezius activity in work and leisure and the relation to shoulder and neck pain. J Appl Physiol. 2006;100:1142–9.PubMedCrossRefGoogle Scholar
  39. 39.
    Linton S, van Tulder M. Preventive interventions for back and neck pain problems. Spine. 2001;26:775–87.CrossRefGoogle Scholar
  40. 40.
    Klaber J, Carr J, Howarth E. High fear-avoiders of physical activity benefit from an exercise program for patients with back pain. Spine. 2004;29:1167–73.CrossRefGoogle Scholar
  41. 41.
    Shrier I. Stretching before exercise; an evidence based approach. Br J Sports Med. 2000;34:324–5.PubMedCrossRefGoogle Scholar
  42. 42.
    Gatchel RJ, Noe C, Gajarj N, Vakharia A, Polatin PB, Deschner M, Pulliam C. The negative impact on an interdisciplinary pain management program of insurance “treatment carve out” practices. J Workmans Compens. 2001;10:50–63.Google Scholar
  43. 43.
    Loisel P, Falardeau M, Baril R. The values underlying team decision making in work rehabilitation for musculoskeletal disorders. Disabil Rehabil. 2005;27:561–9.PubMedCrossRefGoogle Scholar
  44. 44.
    Curtis RS. Values and valuing in rehabilitation. J Rehabil. 1998;64:42–7.Google Scholar

Copyright information

© American Academy of Pain Medicine 2013

Authors and Affiliations

  • Steven D. Feinberg
    • 1
    • 2
    • 3
  • Robert J. Gatchel
    • 4
  • Steven Stanos
    • 5
    • 6
  • Rachel Feinberg
    • 1
  • Valerie Johnson-Montieth
    • 7
  1. 1.Feinberg Medical GroupPalo AltoUSA
  2. 2.Stanford University School of MedicineStanfordUSA
  3. 3.American Pain SolutionsSan DiegoUSA
  4. 4.Department of PsychologyCollege of Science, The University of Texas at ArlingtonArlingtonUSA
  5. 5.Department of Physical Medicine and RehabilitationCenter for Pain Management, Rehabilitation Institute of ChicagoChicagoUSA
  6. 6.Northwestern University Medical School, Feinberg School of MedicineChicagoUSA
  7. 7.Department of PsychologyUniversity of Texas at ArlingtonArlingtonUSA

Personalised recommendations