Comprehensive multidisciplinary pain center approach to the treatment of low back pain.

The primary objective of our program is full function. Other objectives include relief or decrease in pain with the abolition of pain medication, elimination of assistive devices, low or zero disability rating, job satisfaction with return to work and leisure activities without limitations, independence from the health care system, prevention of reinjury, and optimum wellness. The intense, multidisciplinary program described involves a full-time multidisciplinary staff, complete patient involvement, weight control, physical restoration and conditioning, home program maintenance, pacing, body mechanics, energy-saving techniques, reinjury prevention education, pain control and elimination, drug detoxification, behavioral modification, biofeedback, relaxation, imagery, individual and group therapy, family therapy, assertiveness training, stress management, coping skills, vocational counseling, job planning/development/simulation, achievement of maximal function, immediate return to work at discharge, and follow-up care. It is possible to return 86% of these patients to full function and work; they may have some residual pain, which should eventually remit. The 14% who fail are hardcore patients with major behavioral problems, although, to be fair, there are still unanswered questions to resolve. These people have problems that cannot be eliminated within the limit of time with which we have to work with the patient. Lastly, these patients can be disturbed and dangerous, as evidenced by the headline of "A Former Patient Shoots, Kills, New York Neurosurgeon, Self, Wife."