What is Functional Restoration?
When pain medications, injections, conventional physical therapy, or orthopedic surgery fail to provide sustained relief from chronic pain, patients often feel stuck and overwhelmed. Activities become severely limited and physical condition deteriorates. Feelings of frustration and helplessness often give rise to depression, anger, and worry. A vicious circle of pain, physical deconditioning and depression may spiral down, with patients feeling progressively worse and more disabled. All involved are at a loss as to what to do – patients, family members, physicians, employers, and insurance companies. And the blame gets passed around.

Functional restoration programs were developed starting in the 1970’s to provide patients with a way out of this vicious circle of chronic pain. Programs such as EBFR have grown in popularity in this country and around the world because they have proven efficacy (click on Evidence-Based Research) in helping patients break through the misery of chronic pain to reclaim more active and satisfying lives.

Functional restoration programs don’t claim that pain can be eliminated (and beware of treatments or programs that do make this unsupported claim). Instead, in a functional restoration program the focus shifts away from further ineffective medical treatments to an approach that emphasizes coping with pain more effectively while improving physical function, emotional state, and quality of life - even in the face of persistent pain. This is the true goal of a functional restoration program.

Patients often wonder how a functional restoration program can be effective when they’ve failed to benefit from previous medical or surgical treatments and physical therapy. Several factors make the difference:

• Intensity of Treatment - In EBFR, patients meet 3 days per week (M,W,F) from 8:30 AM to 3:00 PM for an eight week rehabilitation program.
• Shift of Focus - Away from reliance on ineffective medical treatments and medications, and toward improved physical and emotional function. This new focus provides a clear and achievable pathway to recovery.
• Teamwork – The patient becomes an active member of the Treatment Team that includes physicians, physical and occupational therapists, and psychologists working together in a coordinated fashion.
• Progressive Physical Reconditioning – Individually paced physical reconditioning and activity tolerance training under careful physical therapist and physician guidance.
• Coping Skills Training – For pain and stress management.
• Psychological Treatment - Of stress, depression, anger, and sleep disturbance.
• Group Support to Reclaim Lost Activities – Group support is essential in making the hard work of rehabilitation go easier.
• Medication Optimization – A careful review of medication benefits and side effects, with taper of medications when appropriate.

Nobody pretends that functional restoration is easy, but it works. The synergistic effects of multidisciplinary functional restoration do bring about significant and lasting improvements for the majority of chronic pain patients.

But not all chronic pain patients are ready for EBFR. Careful patient selection is the key. EBFR is reserved for selected patients who have exhausted medical and surgical treatments, and for whom less intensive levels of care - such as pain medications and physical therapy - have failed to provide sustained improvement in function and quality of life.

Appropriate referrals include:

• Spinal disk disease
• Failed surgeries
• Upper extremity injuries
• Chronic pain syndrome
• Problems in psychological adjustment to injury
• Depression
• Complications with excessive pain medication use
• Disabling functional impairments
• Complex Regional Pain Syndrome (CRPS/RSD)

Appropriate candidates for EBFR must show reasonable rehabilitation potential and a personal willingness to commit to, and work toward, individualized rehabilitation goals, including:

• An individually paced and structured program of physical reconditioning.
• Reclaiming lost functional activities.
• Willingness to work toward mastery and acceptance of residual pain and limitations.
• Motivation for return-to-work and/or independent activities outside the home.
• Willingness to shift focus away from reliance on ineffective medical treatments and medications.
• Willingness to learn new strategies for coping with pain and stress.