Chronic pain is a highly prevalent and often disabling condition among older adults. Research has demonstrated strong associations between chronic pain and substantial morbidity, depression and functional disability. The impact of chronic pain on the healthcare system exceeds $100 billion annually.  There are many treatments that are used to address chronic pain in the United States.  One of the most common is the administration of analgesic medications ( eg, acetaminophen, NSAIDS, opioids).  Many of the older adults that use these medications on a regular basis still report substantial pain levels. These limitations have led to a call for effective nonpharmacological interventions to manage chronic pain.

At Total Rehab & Fitness, physical therapist John Marmarou and cognitive behavioral therapist John Armando have developed an integrated approach to address these issues.  The use of cognitive behavioral therapy in conjunction with physical therapy is proving to be an effective combination when treating this population. “Cognitive behavioral therapy improves patient efficacy and patient adherence to their program. This allows me to keep patients engaged in the physical therapy aspect of the program long enough to for the patient to obtain the results they are looking for,” reports Marmarou.  


John Marmarou, MSPT is Director of Therapy Services for Total Rehab & Fitness (TRF). Call TRF, (formerly known as Exercise Care & Orthopedics) at 856-424-5552 and take the first step to less pain and better health. TRF is a multidisciplinary rehabilitation center that offers physical therapy, occupational therapy, speech therapy, and counseling services. TRF is conveniently located at 1111 Marlkress Road in Cherry Hill, right off of Route 70 East and minutes from exit 34 on 295.

“The use of Cognitive Behavioral Therapy helps patients to explore and develop alternative ways of viewing their chronic pain, depression, or anxiety.  Patients first learn to identify unhelpful patterns of thinking, and then learn to generate thoughts and behaviors that help them to cope more successfully.  Underlying this therapy, is the notion that a person’s beliefs, attitudes, and behaviors play a central role in determining his or her overall pain experience,” Armando explains.                                                                                    

At Total Rehab & Fitness, Marmarou and Armando talk on a regular basis about patients that are involved in this integrated approach to healthcare.  “The communication between John and myself gives me a stronger understanding of where the patient is physically. Addressing the chronic patient with this integrated approach allows me to use the cognitive techniques that will be most beneficial to that particular patient,” states Armando.                                                                          

Marmarou and Armando both believe that cognitive behavioral therapy is consistent with physical therapy intervention in that both promote adoption of self management strategies.  Because of these similar approaches, the two have had extremely positive outcomes for patients who suffer from chronic pain.                                

“It really is amazing how much more effective these two disciplines are when used in concert. All of our chronic pain patients have been to physical therapy prior to seeing us and most have been to some form of counseling. For the first time these patients are starting to feel in control of their symptoms,” states Marmarou. According to a journal article in the July 2009 issues of American Family Physician, the mainstay of non-pharmacological approaches when addressing chronic pain is physical exercise.  Total Rehab & Fitness is doing just that.