Multidisciplinary treatment for chronic pain: a systematic review of interventions and outcomes

Objectives. To provide an overview of the effectiveness of multidisciplinary treatments of chronic pain and investigate about their differential effects on outcome in various pain conditions and of different multidisciplinary treatments, settings or durations. Methods. In this article, the authors performed a systematic review of all currently available randomized controlled trials (RCTs) fulfilling the inclusion criteria, by using a recently developed rating system aimed to assess the strength of evidence with regard to the methodological quality of the trials. Results. Compared with other non-disciplinary treatments, moderate evidence of higher effectiveness for multidisciplinary interventions was shown. In contrast to no treatment or standard medical treatment, strong evidence was detected in favour of multidisciplinary treatments. The evidence that comprehensive inpatient programmes were more beneficial that outpatient programmes was moderate. Fibromyalgia and chronic back pain patients tended to profit more substantially than patients with diverse origins or chronic pain diagnoses. No evidence was found that treatment variables, such as duration or programme components, were influential for the success of the intervention. Conclusion. A standard of multidisciplinary programmes should be internationally established to guarantee generally good outcomes in the treatment of chronic pain. Our results highlight the lack of quality of design, execution or reporting of many of the RCTs included in this article. Future studies should more specifically focus on differential effects of treatment components and patient variables, allowing the identification of subgroups, which most probably would profit from multidisciplinary pain programme

Differences in pain, function and coping in Multidimensional Pain Inventory subgroups of chronic back pain: a one-group pretest-posttest study

Contains fulltext : 97819.pdf (publisher's version ) (Open Access)BACKGROUND: Patients with non-specific back pain are not a homogeneous group but heterogeneous with regard to their bio-psycho-social impairments. This study examined a sample of 173 highly disabled patients with chronic back pain to find out how the three subgroups based on the Multidimensional Pain Inventory (MPI) differed in their response to an inpatient pain management program. METHODS: Subgroup classification was conducted by cluster analysis using MPI subscale scores at entry into the program. At program entry and at discharge after four weeks, participants completed the MPI, the MOS Short Form-36 (SF-36), the Hospital Anxiety and Depression Scale (HADS), and the Coping Strategies Questionnaire (CSQ). Pairwise analyses of the score changes of the mentioned outcomes of the three MPI subgroups were performed using the Mann-Whitney-U-test for significance. RESULTS: Cluster analysis identified three MPI subgroups in this highly disabled sample: a dysfunctional, interpersonally distressed and an adaptive copers subgroup. The dysfunctional subgroup (29% of the sample) showed the highest level of depression in SF-36 mental health (33.4 +/- 13.9), the interpersonally distressed subgroup (35% of the sample) a modest level of depression (46.8 +/- 20.4), and the adaptive copers subgroup (32% of the sample) the lowest level of depression (57.8 +/- 19.1). Significant differences in pain reduction and improvement of mental health and coping were observed across the three MPI subgroups, i.e. the effect sizes for MPI pain reduction were: 0.84 (0.44-1.24) for the dysfunctional subgroup, 1.22 (0.86-1.58) for the adaptive copers subgroup, and 0.53 (0.24-0.81) for the interpersonally distressed subgroup (p = 0.006 for pairwise comparison). Significant score changes between subgroups concerning activities and physical functioning could not be identified. CONCLUSIONS: MPI subgroup classification showed significant differences in score changes for pain, mental health and coping. These findings underscore the importance of assessing individual differences to understand how patients adjust to chronic back pain

Health-related quality of life change in patients treated at a multidisciplinary pain clinic

Background Multidisciplinary pain management (MPM) is a generally accepted method for treating chronic pain, but heterogeneous outcome measures provide only limited conclusions concerning its effectiveness. Therefore, further studies on the effectiveness of MPM are needed to identify subgroups of patients who benefit, or do not benefit, from these interventions. Our aim was to analyse health-related quality of life (HRQoL) changes after MPM and to identify factors associated with treatment outcomes. Methods We carried out a real world observational follow-up study of chronic pain patients referred to a tertiary multidisciplinary outpatient pain clinic to describe, using the validated HRQoL instrument 15D, the HRQoL change after MPM and to identify factors associated with this change. 1,043 patients responded to the 15D HRQoL questionnaire at baseline and 12 months after the start of treatment. Background data were collected from the pre-admission questionnaire of the pain clinic. Results Fifty-three percent of the patients reported a clinically important improvement and, of these, 81% had a major improvement. Thirty-five percent reported a clinically important deterioration, and 12% had no change in HRQoL. Binary logistic regression analysis revealed that major improvement was positively associated with shorter duration of pain (Peer reviewe

Sind Zuweiser und Patienten nach einer Rheumatologischen Interdisziplinären Schmerz-Sprechstunde zufrieden?

Das Ziel dieser Qualitätssicherungskontrolle bestand darin, die Zuweiser- und Patientenzufriedenheit nach der Rheumatologischen Interdisziplinären Schmerz-Sprechstunde (RISS) zu evaluieren. Die Prävalenz an chronischen, muskuloskelettalen Beschwerden ist weltweit zunehmend. Im klinischen Alltag stellen wir fest, dass die Wartezeiten für diagnostische interdisziplinäre Abklärungen immer länger werden. Unserer Meinung nach stellt die RISS eine Möglichkeit dar, um den Zuweisern eine Zweitmeinung zu geben und die therapeutische Allianz sowie Patientenführung zu verbessern. Die Patienten wurden in einem longitudinalen Querschnittsdesign mit einem Follow-up von drei Monaten nach der interdisziplinären (ärztlich, physio-/ergotherapeutisch und psychologisch) Abklärung analysiert. Durchschnittlich zeigten die Patienten einen akzeptablen Zufriedenheitsgrad. Die RISS wurde von Zuweisern als positiv empfunden. Bemerkenswert ist, dass ein grosser Anteil der Zuweiser die RISS weiterempfehlen würde. Aus Sicht der Kliniker scheinen solche Triagen für ein effektives Patienten-Management vorteilhaft zu sein. Schlüsselwörter: Abklärung, ambulante - Interdisziplinäre Sprechstunde - Schmerz, chronische

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”

Translation, transcultural adaptation, reliability and validity of the patient satisfaction questionnaire in german

Objectives To translate the Patient Satisfaction Questionnaire (PSQ) from French to German, to undertake transcultural adaptation, and to test reliability and validity. Design German translation according to sequential forward and backward translation approach, and transcultural adaptation by a consensus process. Validity testing was assessed in a cross-sectional study. Setting Outpatient physiotherapy department of a multidisciplinary clinic. Participants One hundred and twenty-three outpatients with musculoskeletal health disorders after completion of outpatient physiotherapy. Main outcome measures Test–retest reliability was quantified using the intraclass correlation coefficient (ICC 2,1), and Chronbach's alpha was calculated to assess internal consistency of the questionnaire. A factor analysis was performed to investigate the factor structure of the questionnaire. No comparable gold-standard measurement of patient satisfaction was retrieved. The construct validity was assessed using Spearman's rank correlation coefficients between the most indicative item and the global scale excluding this item. Results Translation and transcultural adaptation according to international guidelines did not produce any content or language problems. For 23 test–retest questionnaires, the ICC ranged from 0.74 (Item 10) to 0.92 (Item 11), corresponding to a Chronbach's alpha ranging from 0.85 to 0.96. On Item 12, correlations of 0.53–0.83 were obtained for the subscores and 0.79 for the total score. High values were obtained for content validity and face validity. Conclusions The PSQ in German proved to be good in terms of practical application, comprehensibility, internal consistency, reliability and validity. It is suitable for use to record patient satisfaction after outpatient physiotherapy in German-speaking areas