Multidisciplinary Pain management: Psychosocial Outcomes and Effect on Neurophysiological Responses to Pain

Background: The efficacy of UK National Health Service (NHS) multidisciplinary pain management programmes (PMPs) is currently measured using self-report questionnaires. Whilst subjective measurements provide important information about personal experiences, they cannot reveal underlying changes in cortical activity related to pain that may also accompany PMP treatment. There is no objective measurement of treatment efficacy currently available. This thesis contains studies of two NHS PMPs that differ in their psychological approach. The effect of these treatments was assessed using self-report questionnaire measures, and a newly developed neurophysiological assessment technique. Methods: Studies examined the effect of a cognitive-behavioural therapy (CBT) based PMP, and an acceptance and commitment therapy (ACT) based PMP, upon questionnaire measures of psychological, physical, and social health, as well as measures of coping and acceptance. Further studies examined pre- to post-treatment changes in patients’ cortical pain processing measured using electroencephalography (EEG), as well as in healthy and patient (waiting list/treatment as usual) control groups. The effect of treatment on contact heat evoked potentials (CHEPs), and on changes in power spectral density (PSD) following exposure to medium duration tonic pain (90s cold pressor test) was investigated. Results: Small but significant (p<.05) improvements in self-report measures of mental health, coping, and acceptance were found in patients following both CBT- and ACT-based PMPs. There were differences in the effect of PMPs on measures of anxiety, depression and catastrophising, with the ACT-based programme data showing slightly larger effect sizes. Neurophysiological testing revealed no pattern of effect upon CHEPs, however there were pre- to post-treatment differences in the effect of tonic pain upon PSD. Alpha (α) and theta (θ) rhythms were significantly (p<.05) reduced pre-treatment in the CBT group (n=12); post-treatment this effect was not iv observed. There were no pre- to post-treatment differences in the ACT group (n=4) and there were also no changes in either healthy (n=14) or waiting list (n=13) control groups between test sessions. Conclusion: Both PMPs studied brought about small but significant improvements in patients’ perceived mental and physical health. Despite their differences both programmes were clinically beneficial to patients in terms of self-report measures. Measurable change was observed in the cortical response to pain pre- to post-treatment with a CBT-based PMP, most likely due to a change in cognitive appraisal of painful signals brought about by taking part in the PMP. Results imply the possible use of neurophysiological assessment to identify patients who may benefit most from treatment, to match treatments to patients’ individual psychological and neurophysiological profile, and to more closely monitor treatment efficacy

Electroencephalographic evoked pain response is suppressed by spinal cord stimulation in complex regional pain syndrome: a case report

Spinal cord stimulation (SCS) is considered as an option for the management of complex regional pain syndrome (CRPS). Hyperalgesia, an increased pain response to a mechanical or thermal stimulus at normal or increased threshold is a common feature of CRPS. Animal studies have demonstrated that SCS significantly reduces mechanical hyperalgesia. These studies suggest that SCS mechanisms may involve reduction of glial activation at spinal cord level and/or activation of μ-opioid and δ-opioid receptors. However, in humans it has been observed that SCS had no effect on experimental pain thresholds and did not produce decreased sensitivity for pressure, warmth, and cold induced pain in CRPS patients. The majority of currently available studies on the effectiveness of SCS, including those using quantitative sensory testing (QST) rely on patient reported outcomes such as visual analogue or numerical rating scales. The current case report investigates the effectiveness of SCS based on electroencephalogram (EEG) analysis of contact heat evoked potentials following experimental induction of thermal stimuli

An overview of treatment approaches for chronic pain management

Pain which persists after healing is expected to have taken place, or which exists in the absence of tissue damage, is termed chronic pain. By definition chronic pain cannot be treated and cured in the conventional biomedical sense; rather, the patient who is suffering from the pain must be given the tools with which their long-term pain can be managed to an acceptable level. This article will provide an overview of treatment approaches available for the management of persistent non-malignant pain. As well as attempting to provide relief from the physical aspects of pain through the judicious use of analgesics, interventions, stimulations, and irritations, it is important to pay equal attention to the psychosocial complaints which almost always accompany long-term pain. The pain clinic offers a biopsychosocial approach to treatment with the multidisciplinary pain management programme; encouraging patients to take control of their pain problem and lead a fulfilling life in spite of the pain. © 2016 Springer-Verlag Berlin Heidelber