The Effect of Pain Rehabilitation Program in Reducing Depression

Pain rehabilitation program involves a holistic approach, such as routine medical, psychological and physical intervention in an 8 hour-a-day, 21-30 treatment day programs. The efficacy of multidisciplinary pain management programs has been found helpful, particularly in a daily intensive approach, in decreasing pain and improving function. Treatment includes medication tapering of pain and muscle-relaxers, use of antidepressants, cognitive-behavioral psychotherapy (group and individual) ...etc. Rehabilitation considers the biological, psychological social and occupational factors that contribute to the individual's wellbeing. The purpose of this study is to address the co morbidity between depression and chronic pain and to assess the impact of a multidisciplinary pain rehabilitation program on the level of depression and perceived pain. Changes in depression and pain are observed preand posttreatment using the BDI-II and a self-report measure of pain, at evaluation, day of admittance and at discharge. The archival clinical sample was comprised of 70 Iranian women the used service Shiraz Ebnesina Hospital patients who completed a multidisciplinary pain rehabilitation program, ranging from 21 to 30 day treatment. Results indicated significant reduction of depression at completion of program. Our findings support the effectiveness of efficacy of pain rehabilitation multidisciplinary pain rehabilitation and it's usefulness in reducing depression. Depression was hypothesized to decrease by the end of pain management treatment. Key word: Multidisciplinary Pain Program Clinical Depression Chronic pain Rehabilitation Mental disorder Major depression. INTRODUCTION approaches in improving pain and functional restoration. Depression has affected millions of people in the Iran. increased physical activities to enhance endurance and There are many factors that can initiate the onset of conditioning, antidepressant use to lower pain depression, such as belonging to a minority group, perception, participation with other individuals with economic and social stressors and histories of similar conditions, as well as coping strategies focused psychological distress. Depression is a serious medical on active approaches in reducing pain intensity—all of illness. It is defined as persistent feelings of which are also serve as traditional approaches in the hopelessness, sadness, anxiousness, guilt and loss of treatment of depression. Therefore, the treatment of interest in once pleasurable activities that can last for chronic pain can also function to reduce depression. weeks at a time (National Institute of Mental Health). Nearly 20% of the adulthood, 25% women's, 23% staff Literature Review women met the criteria for probable clinical depression Chronicle Pain: Chronic pain is defined as pain last more in Iran. Clinical depression is a frequently associated than six months, is ongoing and may continue for the mental health disorder found in patients with chronic remainder of the person’s life [1]. The estimated 62 pain. Studies have indicated that intensive daily percentage of individuals suffering from chronic pain, that multidisciplinary pain management programs are more also exhibit signs of depression, varies greatly from weak effective than non-intensive or non-multidisciplinary to significant results [2]. The projected rate of depression Such programs aid management of pain by facilitating World Appl. Sci. J., 21 (5): 774-777, 2013 775 amongst this population is believed to be four times A great deal of research has been conducted on the higher than that found in the general population [3]. Many of the symptoms associated with chronic pain mirror the diagnostic criteria for Major Depression. For example, chronic pain often results in social isolation, withdrawal, feelings of hopelessness, sleep difficulties, loss of interest in activities, financial strain and lack of energy -all of which are common symptoms of depression as defined by The Diagnostic and Statistical Manual of Mental Disorders, fourth edition (DSM-IV). If depression and chronic pain share similar symptomatologies will treatment in a pain management rehabilitation program additionally serve to treat depression. Clinical Depression: Clinical depression is a medical similar to pneumonia that even the strongest person cannot overcome without treatment. Clinical depression is similar to heart disease and cancer in that all of us have a susceptibility to each. If we have family history of one of these illnesses our susceptibility increases. This explains how some develop a clinical depression only after extraordinary stressors and other develop clinical depression seemingly out of the blue. Clinical depression is a very common illness that affects approximately3-5% of the population at any one time. There is a 20% chance of having an episode of clinical depression at some point in one s life. The percentages are similar for the general population and college student [2]. Multidisciplinary Pain Program: The subjects of this study were treated through a nationally accredited, Commission on Accreditation of Rehabilitation Facilities (CARF), multidisciplinary rehabilitation program for managing chronic pain, that involves a holistic approach, such as routine medical, psychological and physical intervention in an 8 hour-a-day, 21-30 treatment day program. The efficacy of multidisciplinary pain management programs has been found helpful, particularly in a daily intensive approach, in decreasing pain and improving function [4]. Treatment includes medication tapering of pain and muscle-relaxers, use of antidepressants, cognitive-behavioral psychotherapy (group and individual), physical therapy, occupational therapy, vocational counseling, group education and biofeedback. Rehabilitation considers the biological, psychological social and occupational factors that contribute to the individual's wellbeing. relationship between depression and chronic pain (5). Handler hypothesized depression to be the result of the chronic pain patient’s decrease of both physical and social activities. [6] Often the result of the chronic pain patient’s decrease of both physical and social activities. Often the result of chronic pain is the fear and avoidance of activity due to re-injury or aggravation of pain. Such inactivity not only leads to muscle decay, loss of strength and energy and increased pain perception, but also has psychosocial ramifications that occur from social isolation, withdrawal and interpersonal conflict. Stressors and events that occur in the pain population may therefore account for the depression [7] and perhaps contribute to the predictive nature of chronic pain in forecasting future depression [8]. Hypothesis: The aim of this study is to show the effect of pain rehabilitation program on the level of depression in Iranian women. This present study hypothesizes depression and will significantly decrease by completion of the program. MATERIALS AND METHODS Participants: The archival clinical sample was comprised of 70, patients women 35, experimental group and 35 control group, who completed a CARF accredited, multidisciplinary pain management program through Progressive Rehabilitation Association in Shiraz Ebnesina Hospital. Treatment ranged from 21 to 30 program days, for 8 hours a day. All patients had identified chronic pain and were admitted due to work related injury. Measure: The 21 item BDI-II, self report instrument, total score was used to measure depressive symptom logy [9]. A commonly used general measure of depression severity, the BDI-II is used over a wide-range of populations, including chronic pain [5]. The BDI-II assesses the degree of depressive symptoms on a scale of 0-63, yielding four categories: minimal, mild, moderate and severe. It has respectable psychometric properties, demonstrating good internal consistency (alpha =.91), decent test-retest reliability (r =.93) and strong construct validity [10]. Procedures: The Beck Depression Scale-II (BDI-II) was administered to patients at three separate intervals to measure pre and post treatment efficacy. World Appl. Sci. J., 21 (5): 774-777, 2013 776 The first administration took place during the initial evaluation, when assessing whether the patient is to likely benefit from a multidisciplinary pain management program. Typically there is a one to two month delay between evaluations and the beginning of treatment. The second administration of the BDI-II was conducted on the first day of entering treatment. The final administration was completed on the day of discharge. Data Analysis: The Statistical Package for the Social Sciences (SPSS) was utilized to analyze the data. Descriptive statistics were generated for each demographic variable. The descriptive statistics reported were frequencies, percentages, means and standard deviations. A repeated-measures ANOVA was constructed to analyze the change in severity of depression using the BDI-II (dependent variable) and pain perception (dependent variable), over the course of treatment time (independent variable). The length of time of initial evaluation to admittance of treatment is co-varied to note possible discrepancies with the wait time for receiving treatment.