Pain Management: Functional Restoration for Chronic Low-Back-Pain Clients

© Springer International Publishing Switzerland 2015
Ingrid Söderback (ed.)International Handbook of Occupational Therapy Interventions10.1007/978-3-319-08141-0_48

48. Pain Management: Functional Restoration for Chronic Low-Back-Pain Clients

Laura Stana1, Anne Bouchez1, Serge Fanello1 and Isabelle Richard 

Departement de medecine physique et readaptation CHU-C3RF, University of Angers, Angers, France



Isabelle Richard


Functional restoration is a concept for intervention of low back pain that has been developed by Mayer et al. (Spine 10:765–772, 1985). It relies on the concept that disability and participation restriction among clients with low back pain is the result of complex interactions among pain, physical deconditioning induced by inactivity, and psychosocial issues. The social cost, mainly indirect costs, induced by sick leave payments for chronic low back pain is high, and this has led to the development of multidisciplinary programs that include occupational therapy interventions.

Coping behaviorErgonomicsLow back painSick leaveWeight lifting

Movement is not that dangerous, I can make it!Client


Chronic low back pain

is pain of the lumbar region lasting for more than 3 months.

Functional restoration

is the intervention program for nonspecific low back pain (i.e., infectious and tumor diseases are excluded) and other musculoskeletal diseases. The program is not aimed at reducing the level of pain , but rather focuses on ­physical reconditioning and coping strategies (Schonstein et al. 2003).


Low back pain is a biopsychosocial issue. Treatments exclusively aimed at the biomedical aspects of low back pain, such as prescription of analgesic medicine, surgery, and corsets, are effective in the acute phase.

Multidisciplinary functional restoration programs have been used in the chronic phase of low back pain since the 1980s. Although differences among the various programs exist, they share a common framework, including (1) physical ­reconditioning, which is achieved by the clients’ participation in intensive physical activities; (2) psychological counseling aimed at the development of coping mechanisms; and (3) modifications of the work environment (Poireaudeau et al. 2007; Schonstein et al. 2003).


The objective of the functional restoration programs is that the clients return to work and resume social and leisure activities.


Candidates for the Intervention

Functional restoration is indicated for clients suffering from chronic low back pain of nonspecific origin . Some programs are embedded in public policies aimed at reducing sick leave and enrolling only clients with work contracts (Loisel et al. 2003).


The incidence of chronic low back pain in developed countries ranges between 60 and 90 %. The prevalence is estimated at 5 %. In the majority of cases (85–95 %), pain and disability disappear within 3 months (Müllersdorf and Soderback 2000).


The functional restoration programs are conducted by multidisciplinary teams and provided in rehabilitation outpatient facilities. They usually last for 3–5 weeks, and clients participate full time or part time.

May 21, 2017 | Posted by in GENERAL | Comments Off on Pain Management: Functional Restoration for Chronic Low-Back-Pain Clients
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