Interdisciplinary Pain Rehabilitation Programs: Evidence and Clinical Real-World Results

Chronic pain conditions are influenced by and interact with physical, psychological, social, and contextual factors. These conditions are associated with psychological distress, poor health, sick leave, and high socio-economic costs. Therefore, modern clinical practice applies a biopsychosocial (BPS) framework. Interdisciplinary pain rehabilitation programs (IPRPs) for chronic pain distinguish themselves as well-coordinated complex interventions. This chapter describes the contents of such programs. We will briefly review the evidence for IPRPs and discuss problems when evaluating these complex interventions. Furthermore, we will report practice-based results from a large Swedish pain registry—the Swedish Quality Registry for Pain Rehabilitation (SQRP). The SQRP collects data from a relevant special clinical department in Sweden—i.e., real-life outcomes will be depicted. Characteristics of patients that benefit the most from IPRPs will be described and discussed. The indications for IPRPs will also be presented. Finally, we will discuss how to improve rehabilitation for chronic pain patients

Endothelial function in healthy women and in women with primary Raynaud´s phenomenon

Endothelial function, assessed as the vasoregulatory effect of nitric oxide (NO), was examined (a) in healthy women with respect to season, time of day, and time in the menstrual cycle, (b) in men, to examine the influence of gender, and (c) in women with primary Raynaudís phenomenon (PRP). To this object, plasma concentrations and urinary excretion of nitrate and cyclic guanosine 3í:5í-monophosphate (cGMP) were determined. In addition, endothelium-dependent vasodilation was assessed by ultrasound determinations of flow-mediated vasodilation (FMD%) in the brachial artery that was contrasted with endothelium-independent vasodilation i.e. nitroglycerine-induced vasodilation (NTG%). Plasma concentrations and urinary excretion of nitrate and cGMP did not display seasonal, diurnal, or menstrual cycle variation in healthy women. FMD% and NTG% were stable throughout the menstrual cycle, but displayed separate patterns of diurnal variation. Determinations of nitrate, cGMP, FMD%, and NTG% did not reveal any gender differences. Women with PRP displayed a season-dependent disturbance in their plasma cGMP response to whole body cooling (WBC). Plasma cGMP levels in healthy women increased in response to WBC both in the summer and in the winter, whereas women with PRP displayed this ìhealthyî pattern only in the summer. Plasma nitrate levels and FMD% did, however, not change in response to WBC, either in PRP or in controls. These data indicate that blood and urine samplings for nitrate- and cGMP-determinations in healthy women do not require standardisation for season, time of day, phase in the menstrual cycle, or gender. FMD% examinations do not have to be standardised for time in the menstrual cycle or for gender, but should be performed at the same time of the day to minimise the physiological variations. The idea of a season-linked endothelial dysfunction in PRP patients, raised by the inadequate plasma cGMP response to WBC in the winter, was not supported by assessments of plasma nitrate and FMD%. However, the season linked disturbance of the plasma cGMP response to WBC in PRP, was reproducible, and could represent an important clue in revealing the culprit lesion/-s in PRP

Acute and long-term psychiatric side effects of mefloquine:A follow-up on Danish adverse event reports

The aim of the study was to explore the profile of acute and long-term psychiatric side effects associated with mefloquine

Spreading of Pain in Patients with Chronic Pain is Related to Pain Duration and Clinical Presentation and Weakly Associated with Outcomes of Interdisciplinary Pain Rehabilitation: A Cohort Study from the Swedish Quality Registry for Pain Rehabilitation (SQRP)

Introduction: The extent to which pain is distributed across the body (spreading of pain) differs largely among patients with chronic pain conditions and widespread pain has been linked to poor quality of life and work disability. A longer duration of pain is expected to be associated with more widespread pain, but studies are surprisingly scarce. Whether spreading of pain is associated with clinical presentation and treatment outcome in patients seen in interdisciplinary multimodal pain rehabilitation programs (IMMRPs) is unclear. The association between spreading of pain and (1) pain duration (2) clinical presentation (eg, pain intensity, pain-related cognitions, psychological distress, activity/participation aspects and quality of life) and (3) treatment outcome were examined.Methods: Data from patients included in the Swedish Quality Registry for Pain Rehabilitation were used (n=39,916). A subset of patients that participated in IMMRPs (n=14,666) was used to examine whether spreading of pain at baseline predicted treatment outcome. Spreading of pain was registered using 36 predefined anatomical areas which were summarized and divided into four categories: 1– 6 regions with pain (20.6% of patients), 7– 12 regions (26.8%), 13– 18 regions (22.0%) and 19– 36 regions (30.6%).Results: More widespread pain was associated with a longer pain duration and a more severe clinical picture at baseline with the strongest associations emerging in relation to health and pain aspects (pain intensity, pain interference and pain duration). Widespread pain was associated with a poorer overall treatment outcome following IMMRPs at both posttreatment and at a 12-month follow-up, but effect sizes were small.Discussion: Spreading of pain is an indicator of the duration and severity of chronic pain and to a limited extent to outcomes of IMMRP. Longer pain duration in those with more widespread pain supports the concept of early intervention as clinically important and implies a need to develop and improve rehabilitation for patients with chronic widespread pain

Outcomes of Interdisciplinary Pain Rehabilitation Across Subgroups of the Multidimensional Pain Inventory : A Study From the Swedish Quality Registry for Pain Rehabilitation

Introduction The Multidimensional Pain Inventory (MPI) is frequently used in the assessment of chronic pain. Three subgroups have been derived from MPI: adaptive coper (AC), dysfunctional (DYS), and interpersonally distressed (ID). The primary aim of this study was to examine whether outcome of Interdisciplinary Multimodal Pain Rehabilitation Programs (IMMRPs) differed across the MPI subgroups. Methods Patients with chronic pain (N = 34,513), included in the Swedish Quality Registry for Pain Rehabilitation, were classified into MPI subgroups and a subset that participated in IMMRPs (N = 13,419) was used to examine overall treatment outcomes using a previously established Multivariate Improvement Score (MIS) and 2 retrospective patient-evaluated benefits from treatment. Results The subgroups differed on sociodemographic characteristics, pain duration, and spatial spreading of pain. DYS and ID had the best overall outcomes to MIS. AC had the best outcomes according to the 2 retrospective items. Transition into other subgroups following IMMRP was common and most prominent in DYS and least prominent in AC. Conclusion The validity of the MPI subgroups was partially confirmed. DYS and ID had the most severe clinical presentations at baseline and showed most improvement following IMMRP, but overall severity in DYS and ID at post-treatment was still higher than in the AC group. Future studies should examine how processes captured by MPI interact with neurobiological, medical, sociodemographic, and adaptation/coping factors and how these interactions impact severity of chronic pain and treatment outcome.Funding Agencies|Swedish Research CouncilSwedish Research CouncilEuropean Commission [2018-02470]; County Council of ostergotland [LIO-608021]</p

Prevalence of long-term opioid therapy in a chronic non-cancer pain population attending a university-based tertiary pain clinic in Sweden. A cross-sectional study

BACKGROUND: Opioid therapy has become a common treatment for chronic pain despite accumulating evidence regarding harm and the lack of data to support efficacy for long-term treatments. The prevalence of opioid treatments in Swedish patients with chronic non-cancer pain is unknown. Hence, the present study aimed to assess a short-term period prevalence of prescribed opioid-use and long-term opioid therapy (LTOT) in a population with complex chronic non-cancer pain.METHOD: The study population consisted of 1613 patients suffering from chronic non-cancer pain and referred to a university-based tertiary pain clinic in Sweden during 2015-2017. Data from a 360-day period prior to consultation were extracted from the Swedish Quality Registry for Pain Rehabilitation (SQRP) and Swedish Prescribed Drug Register (SPDR). Milligram morphine equivalents per day (MME/day) for dispensed opioids were analysed for a 90-day period preceding consultation and long-term opioid therapy (LTOT) was determined for the entire 360-day period.RESULTS: The 90-day prevalence was 38% (CI 36-40,8) and the 360-day prevalence was 22.3% (n=360 with CI 20.4-24.4).CONCLUSION: The prescribing rates of opioids in a Swedish population with complex non-cancer chronic pain were high; two in five patients were dispensed an opioid within a 90-day period prior to consultation

LONG-TERM OPIOID THERAPY AND SIGNS OF OPOID USE DISORDERS IN A CHRONIC NON-CANCER PAIN POPULATIONAT A TERTIARY PAIN CLINIC IN SWEDEN, A CROSS-SECTIONAL STUDY

Förekomst av kända riskfaktorer eller tecken på opioidberoende hos patienter med långvarig opioidbehandling på grund av kronisk smärta

Effects of interdisciplinary pain rehabilitation programs on neuropathic and non-neuropathic chronic pain conditions – a registry-based cohort study from Swedish Quality Registry for Pain Rehabilitation (SQRP)

Abstract Background and aim Neuropathic pain arises as a direct consequence of a lesion or disease affecting the somatosensory system. Pharmacological treatments for neuropathic pain often fail despite following guidelines. Interdisciplinary Pain Rehabilitation Programs (IPRP) are an effective intervention for chronic pain conditions. Little research has investigated whether IPRP can benefit patients with chronic neuropathic pain compared to other chronic pain conditions. This study assesses the real-world effects of IPRP on patients with chronic neuropathic pain compared to non-neuropathic patients using Patient-Reported Outcome Measures (PROMs) available in the Swedish Quality Registry for Pain Rehabilitation (SQRP). Methods A neuropathic group of patients (n = 1,654) were identified in two steps. This group was compared to a non-neuropathic group (n = 14,355) composed of common diagnoses (low back pain, fibromyalgia, whiplash associated disorders, and Ehlers-Danlos Syndrome) in relation to background variables, three overall outcome variables, and mandatory outcome variables (pain intensity, psychological distress symptoms, activity/participation aspects and health-related quality of life variables). Of these patients 43–44% participated in IPRP. Results At assessment, the neuropathic group reported significantly (with small effect sizes (ES)) more physician visits the previous year, older age, shorter pain durations, and less spatial extent of the pain (moderate ES). Moreover, for the 22 mandatory outcome variables, we found only clinically insignificant differences according to ESs between the groups. For patients participating in IPRP, the neuropathic group displayed equal or in some cases slightly superior results compared to the non-neuropathic group. Discussion and conclusion After assessing the real-world effects of IPRP, this large study found that neuropathic pain patients can benefit from the IPRP intervention. Both registry studies and RCTs are needed to better understand which patients with neuropathic pain are most suitable for IPRP and to what extent special considerations need to be made for these patients within the framework of IPRP