RESET takes on chronic pain

The Restorative Self-Management Training and Functional Rehabilitation (RESET) program – the first of its kind in the Southeast – helps fill this need.

Pain is an intensely personal experience. Whether it’s short-term and acute or a chronic, ongoing issue over a longer period, pain is inextricably connected to biological, psychological and social/environmental factors that influence mood/stress response, thoughts, physical ability and general well-being (biopsychosocial).

For those who struggle with chronic pain, performing everyday activities can seem insurmountable. Someone fighting chronic pain might also struggle with depression, anxiety or feelings of hopelessness. On top of that, adolescents with chronic pain may feel as though they are falling behind their peers, who are developing increasing independence while they are not.

In fact, those with chronic pain and severe functional disability typically miss lots of school or must switch to alternative methods, don’t see friends as often or engage in many of their previously preferred leisure activities, and spend much time at various medical appointments.1 For these patients, the annual economic burden is upward of $19 billion. 2

“Despite it impacting one in four youth, 3 there is a general lack of knowledge in the medical and lay communities regarding pediatric chronic pain and its treatment, which lends itself to limited resources for patients and providers,” said Kate Gamwell, PhD, director of Pediatric Pain Psychology and Rehabilitation at Prisma Health Children’s Hospital in the Upstate, and a Clinical Assistant Professor in Pediatrics at the University of South Carolina School of Medicine Greenville. “It’s difficult for patients to find the gold standard of care, which is comprehensive, evidencebased and brings together multiple specialties to help restore the patient’s functional abilities and quality of life. For youth with chronic pain accompanied by severe disability whose functioning hasn’t significantly improved through prior multidisciplinary outpatient treatment, an intensive interdisciplinary pediatric pain treatment, or IIPT, program may be necessary.”4

RESET is an IIPT program housed in Prisma Health’s Roger C. Peace Rehabilitation Hospital in Greenville. The program, designed for patients ages 12–19, recently treated its first pilot patient – with positive results.

From struggling to looking happily ahead

The program’s pilot patient was admitted to RESET for a four-week stay for amplified musculoskeletal pain. At admission, the patient was unable to perform daily chores at home and found favorite activities, such as baking, too difficult to manage given the pain and physical deconditioning. In addition, the patient lacked healthy habits (sleep hygiene, diet, exercise, hydration) and struggled with online school due to a lack of stamina.

RESET sample schedule

During the program, the patient (who requests anonymity) stayed at Roger C. Peace and followed a highly structured schedule requiring involvement from 8 a.m.–5 p.m. This planned daily routine involved working with the RESET team, which included a physician, nurse practitioner and psychologist who specialize in pain management; occupational, physical, recreational, and speech therapists; and other holistic/complimentary interventionists such as nutrition, acupuncture, spiritual care and massage therapists. This collaborative group’s goal was to increase strength, mobility and selfmanagement while recovering daily functions for the patient.

RESET also engages parents or caregivers in the patient’s ongoing treatment, including parent pain psychology and parent yoga sessions, and the ability to shadow some physical therapy, occupational therapy, pain psychology or other sessions. Caregivers can also see the patient routinely throughout the stay, which enables the patient to receive support and encouragement from loved ones. Caregivers are trained how to be coaches of their child, while also encouraging independent self-management of pain.

After the monthlong program ended, RESET’s pilot patient could walk the length of two football fields independently and had the strength and stamina to engage in physical activity for two or three hours each day. The patient developed new organizational habits and a healthy sleep routine; met hydration and healthy eating goals; and gained a better understanding of how pain interacts with internal thoughts, feelings, behaviors and body responses, as well as how to function and live a fulfilling life despite the presence of pain. The patient’s severe chronic painrelated disability status, in effect for more than a year, was in the low-to-moderate range at discharge and considered minimal at the outpatient follow-up visit.

These new skills allowed the patient to increase strength and mobility, decrease sensory sensitivities, and use a schedule and planner to stay organized. Since discharge, the patient has been successful in dual enrollment and attends in-person college courses; has the time, energy and strength to engage in leisure activities such as cooking; and reports feeling like the goal of pursuing a career in the food and beverage industry is now a reality.

Treating pain holistically

RESET’s strength lies in its science-backed, all-hands-ondeck approach. The program brings together a diverse team with a holistic view of how pain affects the brain and body and how changes made to multiple aspects of daily life can help patients develop self-management skills and increase their ability to attend school and social functions, along with reducing ongoing medical needs and specialty care.

Eligibility requirements for patients

• Age 12–19 (those age 10–21 will be considered on a case-by-case basis)

• Motivated to change their circumstances

• Medically, psychologically and nutritionally stable

• Have seen no significant improvement when using outpatient multidisciplinary care for at least three months

• Have no active or pending lawsuits

• Are not seeking new workups or diagnoses

• Are not seeking disability status

• Have had no seizures or similar events for at least a week before admission

• Have a mental developmental status of at least a 10-year-old

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Patient outcomes

BPI 5 = Brief Pain Inventory, a pain intensity subscale, that rapidly assesses severity of pain in the past week and in the moment

FDI 6 = Functional Disability Inventory, a common measure of physical functioning and disability in youth with chronic pain

PCQ 7 = Pain Coping Questionnaire, dealing with pain subscale, gauges patients’ self-assessment of their confidence in their ability to cope with pain

PSEQ 8 = five items from the Pain Self-efficacy Questionnaire, a measure of patients’ confidence in their ability to live a fulfilling life across domains despite pain