Control of chronic painBMJ 1998; 317 doi: https://doi.org/10.1136/bmj.317.7170.1438 (Published 21 November 1998) Cite this as: BMJ 1998;317:1438
All rapid responses
We welcome the thoughtful review of this neglected but important
topic 1. However we are concerned that this review ignored the intensive
rehabilitation approach to the management of chronic pain.
Taking low back pain as an illustration, intensive rehabilitation
aims to overcome the deconditioning of the body which often follows
prolonged back pain and focuses on the increase in physical activity which
is often orientated towards getting patients back to work. This has been
demonstrated in randomized controlled studies both in Europe 2,3 and
Canada 4. A review of the economic evaluation of back pain interventions
5 suggests that active treatments for back pain have the most favourable
results in terms of minimizing sickness absenteeism.
Further research is needed to assess which of the components of
active rehabilitation and pain management programmes are most effective in
the treatment of intractable back pain in the UK
Consultant in Rehabilitation Medicine and Rheumatology
Northwick Park Hospital and Institute of Medical Research
HARROW, HA1 3UJ
LORRAINE DE SOUZA
Professor of Rehabilitation
Dept. of Health Studies
Isleworth, TW7 5DU
1 Nurmikko T, Nash T, Wiles J. Control of chronic pain. Br Med J
2 Harkapaa K, Mellin G, Jarvikoski A, Hurri H. A controlled study on
the outcome of inpatient and outpatient treatment of low back pain. Scand
J Rehab Med 1990;22:181-188.
3 Bendix A, Bendix T, Labriola M, Boekgaard P. Functional Restoration
for chronic low back pain: Two-year follow-up of two radomised controlled
clinical trials. Spine 1998;23:717-725.
4 Mitchell R, Carmen G. The functional restoration approach to the
treatment of chronic pain in patients with soft tissue and back injuries.
5 Goossens M, Evers S. Economic evaluation of back pain
interventions. J Occupat Rehabil 1997;7:15-32.
Competing interests: No competing interests