According to the American Pain Institute, approximately 50 million people in the United States suffer from pain. Many of them are treated with prescription pain medications. Nora Volkow, MD, director of the National Institute on Drug Addiction, has reported that up to 7% of patients who are prescribed narcotic or opiate analgesics will become addicted. While most people take prescription medications responsibly, an estimated 48 million people have used prescription drugs for nonmedical reasons in their lifetime.1
Some estimates indicate that more than 4.7 million Americans are dependent on prescription painkillers.2-4 According to the Substance Abuse and Mental Health Services Administration, there has been a dramatic increase in narcotic analgesic abuse—117%—from 1994 to 2001.5 With these numbers, it is likely that PTs will come into contact with individuals abusing and/or dependent on prescription medication.
TWO WORLDS MEET
Jim Fent, MS, MFT, RPT, was raised with a father who suffered from chronic back pain and prescription pain medication abuse. Early in his career as a PT, Fent recognized that many of his clients exhibited the same thoughts, behaviors, and attitudes as his father. An intense interest in chronic pain and addiction developed. Fent recognized that he had the knowledge and skills to help people with their physical issues, but his ability and scope of practice stopped there.
Following his passion, Fent returned to school and earned a degree in counseling. He recognized that health care providers needed education and training in this area. "Many therapists," he says, "don't want to believe or acknowledge that their patients abuse prescription medications or even use illegal substances, but the data indicates that it is not uncommon." Fent set out with a goal of helping individuals who suffer from chronic pain and addiction as well as teaching other health care providers how to recognize addiction and make appropriate referrals.
PARTNERSHIP AND COLLABORATION
In 2002, Fent met Marcy Trutalli, MPT, CSCS, and they soon realized their interests and treatment styles were extremely compatible. Fent and Trutalli formed The Rehab Group, based in Murrieta, Calif, to specifically work with individuals and families experiencing chronic pain. In December 2006, The Rehab Group developed a working relationship with A Better Tomorrow Treatment Center, a CARF-accredited substance abuse treatment program also based in Murrieta, provides both residential and outpatient substance abuse treatment to people from all parts of the United States.
Additional Pain Management Products
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"Our next residential client is just as likely to come from New York or Las Vegas as they are from California," says Jerrod Menz, director of program development for A Better Tomorrow. "We currently have clients from Utah, Florida, and New York in our program." The collaboration has proved extremely beneficial to the clients and staff of A Better Tomorrow as well as The Rehab Group.
By working together, the two companies can provide a broad scope of professional services, including physical therapy, chiropractic, massage therapy, psychiatry, psychology, marriage and family therapy, alcohol and drug counseling, interventions, case management, psychological testing, and more.
PROGRAM OPTIONS
The Rehab Group offers two programs or treatment options. The first option is "conventional" or "traditional" physical therapy. This program is for individuals with acute trauma, recent surgery, or pain that is less than 6 months in duration; or individuals who received inappropriate or inadequate prior treatment.
The second option is the Pain Program. This program is for individuals whose pain or pain behaviors are interfering with work, activities of daily living, relationships, or sleep; who are no longer participating in or enjoying hobbies or recreational activities; who have failed conventional physical medicine treatment; who have persistent/chronic pain that has existed beyond the expected healing time; whose physical or mental impairment is greater than expected on the basis of the diagnosed medical conditions; and who are chemically dependent on or are abusing medication.
TREATMENT
The Rehab Group's Pain Program is different from other programs because it is abstinence based. Individuals in the pain program are free from all narcotic medications. Often, a combination of manual therapy, Empi E-stim, Thera Band, Orthogel, and Biofreeze are the modalities utilized. The group's collaboration with A Better Tomorrow offers other advantages, too. "Individuals who are chemically dependent may begin their treatment with A Better Tomorrow's detoxification program," Fent says. "Once stable, they transfer into residential treatment and the Pain Program."
Treatment plans are tailored to each individual's needs with four key areas addressed: biological, psychological, social, and spiritual. A Better Tomorrow's program is 12-step based, which addresses clients' spiritual and recovery needs. In addition to the 12-step program, all residential clients exercise daily at a national fitness chain; participate in anger management, stress management, and chemical dependency courses; and participate in individual and family psychotherapy. Individuals in the Pain Program have access to the on-site gym and one-on-one exercise instruction with direct supervision by a PT.
PTs use multiple methods designed to ameliorate or manage pain symptoms. "The best treatment we provide is focused attention, hope, education, hands-on care, and positive communication—in essence, excellent customer service," Trutalli says.
The aftercare plan is also a critical component of patient recovery. "Most of the time, the aftercare plan includes Orthogel, Biofreeze, Thera Band, and an Empi E-stim," Fent says. "We develop an extensive and detailed aftercare plan which includes referring people to physical therapists and health care providers in their area. As a result, we are building a national referral network," Fent says.
RESULTS AND OUTCOMES
So far, the results have been excellent. In addition to the positive client feedback, The Rehab Group uses the Pain Outcomes Profile recommended by the American Academy of Pain Management. A future goal for The Rehab Group is to obtain Pain Program Accreditation through the American Academy of Pain Management.
Jeff Crider is a contributing writer for Physical Therapy Products. For more information, contact . For more information on The Rehab Group or A Better Tomorrow, contact Jim Fent at .
REFERENCES
- National Institute on Drug Abuse (NIDA). NIH Publication Number 05-4881. August 2005. Rockville, Md: National Institute on Drug Abuse.
- Drug Enforcement Agency (DEA) Diversion Control Report. August 2001. Alexandra, Va: Drug Enforcement Agency.
- Kaplan A. NIDA responds to escalating prescription drug abuse. www.psychiatrictimes.com/display/article/10168/52586. Accessed April 15, 2008.
- National Institute on Drug Abuse (NIDA) InfoFacts: Prescription Pain and Other Medications. www.nida.nih.gov/InfoFacts/Painmed.html. Accessed April 14, 2008.
- US Department of Health and Human Service. Office of Applied Studies, Substance Abuse and Mental Health Services Administration. The DAWN Report: Narcotic Analgesics. January 2003 ed. www.dawninfo.net/pdf/~20NA_10.pdf. Accessed April 14, 2008.
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