Interdisciplinary pain management with pain patients: evidence for its effectiveness

Patient Satisfaction With Chronic Pain Management: Patient Perspectives of Improvement

Integrating satisfaction measures with pain-related variables can highlight global change and improvement from the patients' perspective. This study examined patient satisfaction in an interdisciplinary chronic pain management program. Nine hundred and twenty-seven (n = 927) participants completed pre- and post-treatment measures of pain, depression, catastrophizing, anxiety, stages of change, and pain acceptance. Multiple regression was used to examine these variables at admission and discharge as predictors of patient satisfaction. Pain-related variables explained 50.6% of the variance (R2 = .506, F 22,639 = 29.79, P < .001) for general satisfaction, and 38.9% of the variance (R2 = 0.389, F 22,639 = 18.49, P < .001) for goal accomplishment. Significant predictors of general satisfaction included depression (β = -0.188, P < .001) and the maintenance stage of change (β = 0.272, P < .001). The latter was also a significant predictor of goal accomplishment (β = 0.300, P < .001). Discharge pain-related measures are more influential than admission measures for predicting patient satisfaction. Patient satisfaction is significantly related to establishing a self-management approach to pain.

Pain clinic definitions in the medical literature and U.S. state laws: an integrative systematic review and comparison

BACKGROUND

In response to widespread opioid misuse, ten U.S. states have implemented regulations for facilities that primarily manage and treat chronic pain, called "pain clinics." Whether a clinic falls into a state's pain clinic definition determines the extent to which it is subject to oversight. It is unclear whether state pain clinic definitions model those found in the medical literature, and potential differences lead to discrepancies between scientific and professionally guided advice found in the medical literature and actual pain clinic practice. Identifying discrepancies could assist states to design laws that are more compatible with best practices suggested in the medical literature.

METHODS

We conducted an integrative systematic review to create a taxonomy of pain clinic definitions using academic medical literature. We then identified existing U.S. state pain clinic statutes and regulations and compared the developed taxonomy using a content analysis approach to understand the extent to which medical literature definitions are reflected in state policy.

RESULTS

In the medical literature, we identified eight categories of pain clinic definitions: 1) patient case mix; 2) single-modality treatment; 3) multidisciplinary treatment; 4) interdisciplinary treatment; 5) provider supervision; 6) provider composition; 7) marketing; and 8) outcome. We identified ten states with pain clinic laws. State laws primarily include the following definitional categories: patient case mix; single-modality treatment, and marketing. Some definitional categories commonly found in the medical literature, such as multidisciplinary treatment and interdisciplinary treatment, rarely appear in state law definitions.

CONCLUSIONS

This is the first study to our knowledge to develop a taxonomy of pain clinic definitions and to identify differences between pain clinic definitions in U.S. state law and medical literature. Future work should explore the impact of different legal pain clinic definitions on provider decision-making and state-level health outcomes.

Shelter from the storm; men with chronic pain and narratives from the rehabilitation clinic

OBJECTIVE

To examine the meaning of participating at a rehabilitation clinic in the lives of men with chronic pain.

METHODS

The material consists of qualitative interviews with 10 Norwegian men with chronic neck pain, and was analyzed using narrative method, combined with a gender sensitive perspective.

RESULTS

With references to 'identification of a cause' and 'rebuilding physical strength', the significance of medical expertise initially seemed to be linked to restoring bodily function. In the men's individual lives, however, the meaning of being in rehabilitation extended far beyond achieving manifest treatment goals and was also linked to profound human needs, such as to (re)build a self, to be comforted and connected to others.

CONCLUSION

As rehabilitation clinics may provide a legitimate space in which men's experiences of pain are 'housed', they may constitute significant sources for restitution work, as well as significant shelters against social accusation that they are not really sick.

PRACTICE IMPLICATIONS

We suggest that health professionals should be aware of the social significance rehabilitation clinics may represent for men living with chronic pain.

Efficacy of Cognitive Behavioural Therapy for Patients with Chronic Pain in Singapore

Background: The use of Cognitive Behavioural Therapy (CBT) techniques to manage chronic pain is relatively new and understudied in Singapore. Using data collected from group CBT programmes carried out at the Singapore General Hospital (SGH), we seek to explore the ef- ficacy of the programme on pain intensity, self-efficacy, attitudes towards pain, and emotional factors. We also examined the efficacy of the longer 6- to 9-day group programme versus an abridged 2-day version called the Pacing Programme covering only some aspects of the full group programme. Materials and Methods: Twenty-nine adult patients underwent the intensive 6- to 9-day group programme while another 10 patients underwent the abridged 2-day group programme. The more extensive group programme encompassed teaching patients cognitive- behavioural methods of coping with pain, such as setting goals, pacing, cognitive restructuring by thinking in more positively, distraction, problem solving, sleep hygiene, communication skills, ability to cope with changes, and relaxation techniques. The abridged programme focused mainly on developing pacing skills. Patients were required to fill out questionnaires at the begin- ning of the programme, end of the programme, and at the 1-month and 6-month follow-ups to monitor progress. Results: Preliminary results for the intensive 6- to 9-day group programme indicate decrease in pain and pain distress levels, improvements in management of pain, in- creased confidence to carry out activities despite pain, increased positive self-statements and decreased negative self-statements, decrease in fear of harm and pathophysiological beliefs, as well as decreases in the levels of depression, anxiety, and stress. The abridged 2-day programme yielded little change in pain and pain distress levels, but a slight increase in confidence to carry out activities despite pain. Conclusion: These preliminary results provide some evidence supporting the efficacy of CBT techniques in chronic pain management and contribute to the growing body of evidence for the effectiveness of psychological and behavioural techniques in the management of chronic pain. Key words: Group, Multi-disciplinary treatment, Psychological intervention, Psychotherapy

Behavioral medicine approaches to pain

Pain is a complex, idiosyncratic experience. When pain is the primary complaint for seeking medical attention, understanding of multiple factors is essential in guiding successful treatment. Behavioral medicine, a branch of psychology, has been an integral part of interdisciplinary/multidisciplinay care of pain patients. In this article, we provide an overview of behavioral medicine approaches to pain, including assessment and commonly used therapeutic methods. Particular attention is given to cognitive-behavioral therapy and motivational enhancement therapy.

Evidence-based clinical practice guidelines for interdisciplinary rehabilitation of chronic nonmalignant pain syndrome patients

This is an update to evidence-based practice guidelines for chronic nonmalignant pain syndrome patients first published in 1995 and revised in 1999. The current guidelines recommend interdisciplinary-focused rehabilitation, which is goal-directed and time-limited. Emphasis is placed on educating patients in active self-management techniques that stress maximizing function. Integrated treatment involving medical, psychological/behavioral, physical/occupational therapy, and disability/vocational interventions are recommended on an outpatient basis whenever clinically possible. Patient selection criteria are delineated. Updated references providing evidence-based support for the recommendations are provided, including the use of opioids and sedative-hypnotic medications, injection and block procedures, acupuncture, implantable spinal infusion and stimulation devices, and other invasive spinal surgery procedures such as intradiscal electrothermal therapy. Guideline integration and early detection and intervention with chronic pain syndrome patients are encouraged.

Behavioral medicine approaches to pain

Managing pain patients can be a challenging task for many clinicians because of the complexity of the condition. Pain by definition is a multifactorial phenomenon for which biomedical factors interact with a web of psychosocial and behavioral factors. Behavioral medicine approaches for pain generally address specific cognitive and behavioral factors relevant to pain, thereby aiming to modify the overall pain experience and help restore functioning and quality of life in pain patients. Behavioral medicine focuses on patients' motivation to comply with a rehabilitative regimen, particularly those with chronic, disabling pain. Since patients' own commitment and active participation in a therapeutic program are critical for the successful rehabilitation, the role that behavioral medicine can play is significant. It is not unreasonable to state that success outcomes of the rehabilitative approach depend on how effectively behavioral medicine can be integrated into the overall treatment plan. Past research in general supports this assertion, demonstrating clinical benefit and cost-effectiveness of multidisciplinary interventions that include behavioral medicine. Some of the approaches listed in this paper can be incorporated into clinicians' practice regardless of specialties, and such practice will likely provide helpful venues for managing pain patients.