Thread by @CanadaPain

I teach the (Stanford) CPSMP.

Pain programs/rehab are immensely valuable. They provide support, learning, and critical experience.

But they are established in such a way as to be best suited to the funding model, not to the patient's needs. /1

https://twitter.com/PainChampions/status/1396213242914123779

If you've been out of commission for years, expectations need to be realistic & set up for success.

You're not going to go from virtually bedridden to a full week program just because that's what's demanded.

It's neither rational, medically reasonable, nor sustainable. /2

Program needs to start slowly. One or two afternoons a week, spaced apart, for a few hours. Grow over months.

This would work. Just not set to funding, they want programs that are shorter, more aggressive, and have quantifiable end data. /3

Nobody cares about realistic sustainability, in the best interests of the patients. Medical bootcamp rehab looks good on paper, but...

Establish programs that will work, not just look good.

How many people who take the program return to full pre-injury/illness activity? /4

Surprised if there were any. If there are, they weren't chronic or degenerative, just deconditioned and in need of support.

But for those in dire circumstances, a prolonged gradually increasing program over months would have the best sustainability & success.

They don't exist.