Disclosures: Satyum R. Parikh, MD: Nothing to disclose

Case Description: A 73-year-old male with history of polymyalgia rheumatica presents with over 3 years of worsening neck, shoulder, and hip pain. He reports he has debilitating pain flares every few weeks which has led to the point that he can no longer independently ambulate or carry out any of his activities of daily living. He has been using methotrexate and steroid bursts as needed which have since begun to lose their efficacy in pain control.

Setting: Outpatient Multidisciplinary Pain Management Clinic.

Patient: 73 year old male with history of polymyalgia rheumatica.

Assessment/Results: This patient was initiated in an integrative pain treatment program whereby he was instructed to complete 21 consecutive days 4-5 hour pain management sessions. Under the direction of a physiatrist, he received targeted physical therapy, pain psychology, pain education seminars, and nurse counseling. A focus was placed on strengthening, joint mobilization, gait training, biofeedback, sleep/wake cycle evaluation, as well as psychotherapy. Upon completion of this integrative pain management program, this patient had a nearly sixty percent reduction in his functional pain scores, a one hundred percent increase in functional ambulation, and he has not, to date, sustained an inflammatory exacerbation.

Discussion: Patients with PMR often sustain significant debility as a result of chronic pain. Some evidence exists that exercise therapy is essential for to help control these patients’ symptoms (1, 2). Until now, however, no evidence currently exists regarding the benefit of a targeted, multidisciplinary approach to controlling their pain.

Conclusion : Known mainstays of treatment for PMR include medication such as steroids as well as outpatient exercise therapy (3). This is the first known case to successfully demonstrate the benefit of a multidisciplinary approach for inflammatory arthritis. This patient’s significant improvement in pain and functionality exemplifies intensive targeted therapies as a long-term means of disease modification in an otherwise debilitating disease.

Level of Evidence: Level V

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PM&R Meeting Abstracts - https://pmrjabstracts.org/abstract/an-integrative-pain-program-to-treat-polymyalgia-rheumatica/