[Rehabilitation of chronic myofascial pain disorders].
BACKGROUND
Chronic musculoskeletal pain of diffuse origin affects many, and at a significant cost. Evidence-based guidelines for therapeutic interventions are presented and exemplified.


METHODS
200 patients with chronic myofascial pain and/or fibromyalgia who participated in a 4-week multidimensional rehabilitation programme, were included in the study. The programme included education and pain management in a cognitive setting, various forms of aerobic exercises, myofascial pain treatment, relaxation and medication as needed. The patients filled in questionnaires on arrival, at follow-up after six and 12-months and at discharge. They completed visual analogue scales (pain, fatigue, sleep problems, depression), the Nottingham Health Profile, the Fibromyalgia Impact Questionnaire, global subjective improvement, and during the follow-up period also the physical activity level, changes in quality of life and occupational workload. Work capacity, a tender point count and whether patients met the diagnostic criteria for fibromyalgia were assessed at baseline and at discharge.


RESULTS
Significant improvements were seen in all variables throughout the follow-up period. 30% of the fibromyalgia patients no longer met the diagnostic criteria at discharge. There was a significant increase in quality of life over time. After one year, more patients had returned to work and fewer were off sick, but there was also an increased number on disability pensions. The majority did exercise training on a regular basis.


CONCLUSIONS
Our findings confirm the existing evidence-based guidelines by showing that multidimensional rehabilitation is an effective intervention for patients with widespread chronic pain. It is a challenge for health politicians to change today's common practice towards that described in evidence-based guidelines.
Wigers
Sigrid Hørven
SH
Opptreningssenteret Jeløy Kurbad, Bråtengaten 94, 1515 Moss. sigrid.wigers@c2i.net
Finset
Arnstein
A
D000328:Adult; D000368:Aged; D000700:Analgesics / Q000008:administration & dosage; D002908:Chronic Disease; D015928:Cognitive Behavioral Therapy; D019317:Evidence-Based Medicine; D005081:Exercise Therapy; D005260:Female; D005356:Fibromyalgia / Q000175:diagnosis / Q000523:psychology / Q000534:rehabilitation*; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009209:Myofascial Pain Syndromes / Q000175:diagnosis / Q000523:psychology / Q000534:rehabilitation*; D010147:Pain Measurement; D026741:Physical Therapy Modalities; D011446:Prospective Studies; D011788:Quality of Life; D012064:Relaxation Therapy; D011795:Surveys and Questionnaires; D016896:Treatment Outcome
D000700:Analgesics