Functional Restoration
'Functional Restoration Plan' (FRP) is the name given to a specific rehabilitation plan targeting those suffering from chronic pain after conventional treatment has failed yet they are not deemed suitable for surgery. This may be due to reasons such as anaesthetic risk, other health related factors or simply that no structural cause can be found from the results of further investigations. The latter is not uncommon within the chronic pain setting and in a majority of cases, unless a specific pain generator (cause of pain) can be found, surgery is not indicated as a viable treatment option.
Pain is best thought of in two categories, these being acute and chronic. There is a group that often sits in between called sub-acute but is not necessarily of relevance here. Pain in its acutest form is a generally accepted to be a protective mechanism. It warns of tissue damage be it muscular, ligamentous or bony etc. often occurring alongside a myriad of other symptoms such as spasm and swelling to deter further injury and aid recovery. For a vast majority of people the body will spontaneously recover within 4-12 weeks and all of the effects seen alongside this will dissipate too. Unfortunately, chronic pain can bear all of the attributes seen in acute pain but fails to cease within the normally accepted timescale of 3 months. The pain must arise from the same source (or thought to be so) throughout the duration for the chronic stage to be reached. Although full recovery can still be made beyond this time, the amount of relief, and time taken, becomes more variable when compared to pain that settles within the acute phase.
The reasons why people progress into chronic pain are widely theorised but we don’t really have any sure fast answers and in those circumstances where no structural pain generator can be found, subsequent management has historically been poor at best. Development of maladaptive coping mechanisms and incorrect beliefs about pain in an attempt to normalise the situation often seems the right thing to do in the short term but can often stunt recovery in the long term (see chronic pain for more information regarding this). At this stage, trying to refocus rehabilitation away from pain and more to function and education has been shown to be more effective at breaking the chronic cycle. It is a little like the glass half full or half empty, looking at things from different viewpoints can often change your opinion about them. This is where FRP’s comes in.
A team of experienced professionals will normally be included in a FRP often including physiotherapists and occupational therapists. Exercise is still seen as the mainstay of rehabilitation as through fear, anxiety or pain, many of you will have become very deconditioned however this exercise is tailored to the individual, and although tough, will always be within realistic capabilities. In some classes there may be the involvement of a psychologist to help implement a very effective treatment called Cognitive Behavioural Therapy. These are generally called Pain Management Plans (PMP’s) rather than FRP’s however there is quite a lot of poetic license with this so is worth checking in a class by class manner. The main focus of FRP’s is on what you can do and how to reinforce techniques that will help you to achieve these. People do report significant reductions in pain but this is often not used as a primary goal. Instead, functional goals will be set such as walking tolerance, stair climbing, tasks at work, in fact whatever works for you. At the end of the day, if you cannot reduce your pain but you can do 50% more activity, a majority of people see this as a success.
Pain is best thought of in two categories, these being acute and chronic. There is a group that often sits in between called sub-acute but is not necessarily of relevance here. Pain in its acutest form is a generally accepted to be a protective mechanism. It warns of tissue damage be it muscular, ligamentous or bony etc. often occurring alongside a myriad of other symptoms such as spasm and swelling to deter further injury and aid recovery. For a vast majority of people the body will spontaneously recover within 4-12 weeks and all of the effects seen alongside this will dissipate too. Unfortunately, chronic pain can bear all of the attributes seen in acute pain but fails to cease within the normally accepted timescale of 3 months. The pain must arise from the same source (or thought to be so) throughout the duration for the chronic stage to be reached. Although full recovery can still be made beyond this time, the amount of relief, and time taken, becomes more variable when compared to pain that settles within the acute phase.
The reasons why people progress into chronic pain are widely theorised but we don’t really have any sure fast answers and in those circumstances where no structural pain generator can be found, subsequent management has historically been poor at best. Development of maladaptive coping mechanisms and incorrect beliefs about pain in an attempt to normalise the situation often seems the right thing to do in the short term but can often stunt recovery in the long term (see chronic pain for more information regarding this). At this stage, trying to refocus rehabilitation away from pain and more to function and education has been shown to be more effective at breaking the chronic cycle. It is a little like the glass half full or half empty, looking at things from different viewpoints can often change your opinion about them. This is where FRP’s comes in.
A team of experienced professionals will normally be included in a FRP often including physiotherapists and occupational therapists. Exercise is still seen as the mainstay of rehabilitation as through fear, anxiety or pain, many of you will have become very deconditioned however this exercise is tailored to the individual, and although tough, will always be within realistic capabilities. In some classes there may be the involvement of a psychologist to help implement a very effective treatment called Cognitive Behavioural Therapy. These are generally called Pain Management Plans (PMP’s) rather than FRP’s however there is quite a lot of poetic license with this so is worth checking in a class by class manner. The main focus of FRP’s is on what you can do and how to reinforce techniques that will help you to achieve these. People do report significant reductions in pain but this is often not used as a primary goal. Instead, functional goals will be set such as walking tolerance, stair climbing, tasks at work, in fact whatever works for you. At the end of the day, if you cannot reduce your pain but you can do 50% more activity, a majority of people see this as a success.
