For many people suffering chronic pain, residential courses of pain management and rehabilitation offer the best opportunity for improvement in their function and quality of life.
Unfortunately, nationally there are very few treatment centres offering such courses. One that does is the Bath Centre for Pain Services (BCPS) which is only a short distance from our office. We know the Centre and its staff very well, having arranged funding for many of our clients to receive treatment there over the years. Indeed, they accept referrals from around the country.
However, experience has shown us that whilst the intensive, multi-disciplinary input received by patients on these courses really does help many people, danger lurks around the corner. The problem is that residential courses necessarily cocoon attendees within a highly supportive, almost rarefied, treatment environment for the two, three or four week duration of the course. The danger, however, lies upon their return home; upon their re-emergence into the real world.
It is what I refer to as the ‘crash and burn’ factor.
One reason that courses of rehabilitation are offered on a residential basis is that this allows the patient the best opportunity to focus entirely on themselves and their rehabilitation for the duration of the course. For the very best of reasons, for that limited period of time, family, friends and all of the other usual distractions of life can be pushed to one side.
Many people have travelled a significant distance to attend a course and whilst they are usually provided with a point of contact should problems arise following their discharge, it will often be three months before their first follow-up meeting with the treatment professionals.
Suddenly, the helpful and supportive staff are no longer on tap. Family and friends are keen to talk and catch up. A month’s worth of stored-up domestic and other issues have to be dealt with. Even if you can focus on the daily regime of physical and psychological exercises that have been drummed into you, they now seem far less effective. Very quickly that “end of rehab high” upon which you floated home has evaporated and you start to spiral down.
For this reason it is imperative that before somebody attends an inpatient course of rehabilitation that arrangements are put in place to provide for them local, continued professional support immediately upon the completion of the course. That is the only way to minimise the risk of ‘crash and burn’.
We arrange local assessments, often jointly, with both physical and psychological therapists. These therapists should be put in contact with the course providers prior to the commencement of the course so that information can thereafter be shared. It is also important to put the general practitioner on notice from a medication perspective. Whilst course providers will routinely write to a GP, there is often a delay in correspondence. Advance appointments should be arranged with the GP and the therapists to take place within the first day or two following the end of the course.
Just taking these very simple steps really can make a huge difference to the long term success of the course of treatment.
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