Influence of an outpatient multidisciplinary pain management program on the health-related quality of life and the physical fitness of chronic pain patients

BACKGROUND: Approximately 10 to 20 percent of the population is suffering from chronic pain. Since this represents a major contribution to the costs of the health care system, more efficient measures and interventions to treat these patients are sought. RESULTS: The development of general health and physical activity of patients with chronic pain was assessed in an interdisciplinary outpatient pain management program (IOPP). 36 patients with an average age of 48 years were included in the IOPP. Subjective assessment of well-being was performed at five time points (baseline, post intervention and 3, 6, and 12 months thereafter) by using standardized questionnaires. The study focused on the quality of life survey Medical Outcomes Study Short Form-36, which is a validated instrument with established reliability and sensitivity. In addition, the patients participated in physical assessment testing strength, power, endurance, and mobility. Prior to therapy a substantial impairment was found on different levels. Marked improvements in the psychological parameters were obtained by the end of the program. No success was achieved with regard to the physical assessments. CONCLUSION: Although many different studies have evaluated similar programs, only few of them have attained positive results such as improvements of general quality of life or of physical strength. Often no difference from the control group could be detected only some months after the intervention. In the present study no significant persistent improvement of well-being occurred. Possible reasons are either wrong instruments, wrong selection of patients or wrong interventions

Effect of an Interdisciplinary Outpatient Pain Management Program (IOPP) for chronic pain patients with and without migration background: a prospective, observational clinical study

Objectives. Short and long-term effects of an interdisciplinary outpatient pain program (IOPP) in terms of quality of life, coping strategies, experiencing of pain and pain intensity as well as the influence of age, gender or migration background. Design. Single, prospective cohort with assessments at baseline, post-treatment and 3, 6, 12 months follow-ups. Patients. 175 patients with chronic, non-malignant pain syndromes (32.1% male and 67.9% female; age 43 years±9.6). Intervention. Multi-professional, bio-psychosocial-oriented pain program for the duration of eight weeks. Outcomes. 1) Pain intensity, 2) Pain Disability Index (PDI-G), 3) cognitive and behavioral coping strategies (FESV), 4) Marburger questionnaire about habitual subjective well-being and 5) processing of chronic pain (VEV). The migration background was considered to determine whether this variable influences the clinical outcomes. Results. All mentioned variables, except pain intensity, improved significantly after the program (p<0.05); whereas, after the one-year follow-up, most of the parameters returned to the baseline values. Solely the subscale “pain related psychological strain” remained significantly better compared to baseline (p<0.05). The variable “migration background” influenced the outcomes PDI-G, habitual well-being, and FESV (p<0.001; variance of 16.7% (95% CI [7.8-25.5])). After 12 months, 49.4% showed an improvement in regard to the VEV outcome measurement, 22.6% showed no changes, and 28% showed worsening of the symptoms. Gender and age do not influence the results at 12 months (p=0.408; p=0.964). Conclusion. This study provides evidence for the short-term effect of the IOPP in chronic pain patients as well as the long-term effect for the variable “pain-related psychological strain”

Pain and psychological health status in chronic pain patients with migration background-the Zurich study

The objective of this paper is to investigate whether there were differences in pain and psychological health status in chronic pain patients with and without migration background before and after an 8-week interdisciplinary outpatient pain programme (IOPP). One hundred eighteen consecutively assessed patients were included. Pain and psychological health were recorded prior to and after the intervention, and at the 3-, 6- and 12-month follow-up. The migrant group experienced a statistically significant and clinically relevant higher amount of pain and worse psychological functioning than the non-migrant group at all time points. Statistically significant differences between the groups for the variables depression, anxiety, kinesiophobia and passive coping, in particular catastrophizing, were observed in the short and long term. The non-migrant group improved continuously on all outcome measurements at all time points. The results show differences in outcome for chronic pain patients with and without migration background. High pain intensity, high levels of depression, anxiety and catastrophizing at baseline appear to be major barriers for improvement in a sample of migrant patients when participating in an IOPP. Treatments may have to be tailored to the specific needs of this patient group to better address their poor psychological health status and to improve the course of the pain disorder