Benchmarking outcomes for psychological treatments of chronic pain

Abstract

In an attempt to bridge the widely acknowledged gap between research and clinical practice, this thesis examined the feasibility of benchmarking outcomes for published psychological treatments of chronic pain for application within routine clinical settings. Benchmarking outcomes is relatively common for psychological treatments in the mental health field, but in spite of the prevalence of chronic pain and its known impact on many areas of functioning, the chronic pain literature has previously only considered the generic application of benchmarks for developing services and considering standards for waiting times. Four studies of mixed methodological approaches were conducted. The first aimed to ascertain the extent of similarities between published psychological treatments of chronic pain and treatments delivered in routine clinical settings. This was to ensure that the application of benchmarks from the published literature to routine clinical settings would be meaningful. The second study examined whether the published literature was likely to facilitate the development of benchmarks, and the third sought clarification in terms of outcome domains within which useful benchmarks could be generated. The final study was a meta-analysis of data extracted from the published literature within specified outcome domains. The results suggested that it would be meaningful to apply benchmarks produced from the published literature to routine clinical settings, and that the literature would facilitate the development of benchmarks within several outcome domains. The meta-analysis led to the generation of four benchmarks. These were in the outcome domains of pain experience and physical functioning when compared with waiting list controls, and coping and cognitive appraisal and emotional functioning when compared with active controls. The impact of the design of each study and properties inherent within the literature on the benchmarks generated and their application within routine clinical settings was then considered, prior to suggestions for future research and clinical applications