A Descriptive Longitudinal Study of Chronic Pain Outcomes and Gender Differences in a Multidisciplinary Pain Management Centre

Background: The long-term outcomes of patients with chronic pain treated in a multidisciplinary pain management center remain variable. Objective: This study aims to evaluate the changes in outcomes of patient’s self-reported pain, psychosocial status, health related quality of life and gender differences following treatment in amultidisciplinary pain management centre. Design: A prospective longitudinal cross-sectional study uses questionnaires. Treatment Setting: A pragmatic and individualized patient centered approach in a tertiary level multidisciplinary pain management center. Subjects: Patients with chronic pain referred to the centre from 2004-2010. Outcome Measures: Pain Numerical Rating Scale (NRS), Pain Temporal Description (1 - 6), Pain Self- Efficacy Questionnaire (PSEQ), Depression Anxiety Stress Scales (DASS-21) and Short Form-36 (SF- 36). Follow-up questionnaires were sent at 6 and 12 months after initial assessment. Results: Mean duration of baseline chronic pain was 8.1 years and 61% of chronic pains were involving the musculoskeletal system. At 6 and 12 month follow-ups, 273 and 180 participants had been surveyed respectively. At 6-month follow-up, there were significant improvements on pain intensity (Cohen’s d = 0.8), pain self-efficacy (Cohen’s d = 0.47), depression and stress scores (Cohen’s d = 0.16) and six out of eight domains of SF-36 (Cohen’s d = 0.2 - 0.4). At 12-month follow-up, improvements were maintained on pain intensity, self-efficacy and three out of eight domains of SF-36. There were distinctive pre- and post-treatment gender differences in these outcomes and overall females showed better short- and long-term outcomes than males. Conclusion: Multidisciplinary pain management using an individualized patient centered approach remains an effective treatment for chronic pain in both the short- (6 month) and long-term (12 month). The distinctive pre- and post-treatment gender differences particularly in the psychological outcomes, suggest that it may be beneficial to further delineate and better manage vulnerable patient subgroups.

[1]  M. Jensen,et al.  Changes in readiness to self-manage pain are associated with improvement in multidisciplinary pain treatment and pain coping , 2004, Pain.

[2]  Heiko Reichel,et al.  Intensive interdisciplinary outpatient pain management program for chronic back pain: a pilot study , 2012, Journal of pain research.

[3]  L. McCracken,et al.  General psychological acceptance and chronic pain: There is more to accept than the pain itself , 2010, European journal of pain.

[4]  H. Flor,et al.  Efficacy of multidisciplinary pain treatment centers: a meta-analytic review , 1992, Pain.

[5]  C. Bombardier,et al.  Multidisciplinary rehabilitation for chronic low back pain: systematic review , 2001, BMJ : British Medical Journal.

[6]  F. Blyth,et al.  The utility of the short version of the Depression Anxiety Stress Scales (DASS-21) in elderly patients with persistent pain: does age make a difference? , 2010, Pain medicine.

[7]  Michael J. Constantino,et al.  Comorbid Depression, Chronic Pain, and Disability in Primary Care , 2006, Psychosomatic medicine.

[8]  W. Maixner,et al.  Self-efficacy for arthritis pain: relationship to perception of thermal laboratory pain stimuli. , 1997, Arthritis care and research : the official journal of the Arthritis Health Professions Association.

[9]  J. Fincham.  Response Rates and Responsiveness for Surveys, Standards, and the Journal , 2008, American Journal of Pharmaceutical Education.

[10]  Lili Tian,et al.  A Comparison of the General Linear Mixed Model and Repeated Measures ANOVA Using a Dataset with Multiple Missing Data Points , 2004, Biological research for nursing.

[11]  M. Nicholas,et al.  The pain self‐efficacy questionnaire: Taking pain into account , 2007, European journal of pain.

[12]  S. Woby,et al.  Self‐efficacy mediates the relation between pain‐related fear and outcome in chronic low back pain patients , 2007, European journal of pain.

[13]  Judith A. Feeney,et al.  Adult attachment, anxiety, and pain self-efficacy as predictors of pain intensity and disability , 2006, Pain.

[14]  F. Blyth,et al.  Chronic pain‐related disability and use of analgesia and health services in a Sydney community , 2003, The Medical journal of Australia.

[15]  Jacob Cohen.  Statistical Power Analysis , 1992 .

[16]  Mark P. Jensen,et al.  Changes after multidisciplinary pain treatment in patient pain beliefs and coping are associated with concurrent changes in patient functioning , 2007, Pain.

[17]  David Sheffield,et al.  Race and Sex Differences in Cutaneous Pain Perception , 2000, Psychosomatic medicine.

[18]  D. Turk,et al.  Treatment of chronic non-cancer pain , 2011, The Lancet.

[19]  E. Augustson,et al.  Sex-specific effects of pain-related anxiety on adjustment to chronic pain. , 2000, The Clinical journal of pain.

[20]  P. Hampel,et al.  Effects of gender and cognitive-behavioral management of depressive symptoms on rehabilitation outcome among inpatient orthopedic patients with chronic low back pain: a 1 year longitudinal study , 2009, European Spine Journal.

[21]  R. Fillingim,et al.  Pain tolerance as a predictor of outcome following multidisciplinary treatment for chronic pain: differential effects as a function of sex , 2003, Pain.

[22]  M. Schatman.  Psychological Assessment of Maldynic Pain: The Need for a Phenomenological Approach , 2010 .

[23]  F. Blyth,et al.  Self-management intervention for chronic pain in older adults: A randomised controlled trial , 2013, PAIN®.

[24]  J. S. Skouen,et al.  Return to work after comparing outpatient multidisciplinary treatment programs versus treatment in general practice for patients with chronic widespread pain , 2006, European journal of pain.

[25]  K. Refshauge,et al.  Rasch analysis supports the use of the depression, anxiety, and stress scales to measure mood in groups but not in individuals with chronic low back pain. , 2012, Journal of clinical epidemiology.

[26]  J. Teasdale.  Self-efficacy: Toward a unifying theory of behavioural change? , 1978 .

[27]  J. van Limbeek,et al.  Daily functioning and self-management in patients with chronic low back pain after an intensive cognitive behavioral programme for pain management , 2010, European Spine Journal.

[28]  P. Bech,et al.  Treatment outcome of chronic non-malignant pain patients managed in a Danish multidisciplinary pain centre compared to general practice: a randomised controlled trial , 2000, PAIN®.

[29]  P. Disler,et al.  Managing chronic back pain: impact of an interdisciplinary team approach , 1996, Medical Journal of Australia.

[30]  F. Blyth,et al.  Chronic pain in Australia: a prevalence study , 2001, Pain.

[31]  A. Bandura.  Self-efficacy: toward a unifying theory of behavioral change. , 1977, Psychological review.

[32]  Six month post-treatment deterioration in acceptance (CPAQ-8) and cognitions following multidisciplinary pain treatment , 2014, Journal of Behavioral Medicine.

[33]  L. Campbell,et al.  The unequal burden of pain: confronting racial and ethnic disparities in pain. , 2003, Pain medicine.

[34]  N. Laird,et al.  Using the general linear mixed model to analyse unbalanced repeated measures and longitudinal data. , 1997, Statistics in medicine.

[35]  Cynthia O. Townsend,et al.  Gender differences among patients with fibromyalgia undergoing multidisciplinary pain rehabilitation. , 2007, Pain medicine.

[36]  C. Eccleston,et al.  Systematic review of outpatient services for chronic pain control. , 1997, Health technology assessment.

[37]  J. T. Kvaløy,et al.  The effectiveness of an improved multidisciplinary pain management programme: a 6- and 12-month follow-up study. , 2012, Journal of advanced nursing.

[38]  F. Blyth,et al.  Chronic pain, work performance and litigation , 2003, PAIN®.

[39]  Julie F Pallant,et al.  BMC Psychiatry BioMed Central Research article Rasch model analysis of the Depression, Anxiety and Stress Scales , 2009 .

[40]  M. Cheatle.  Depression, chronic pain, and suicide by overdose: on the edge. , 2011, Pain medicine.

[41]  R. Edwards,et al.  Ethnic Group Differences in the Outcomes of Multidisciplinary Pain Treatment , 2011, Journal of musculoskeletal pain.

[42]  I. Jensen,et al.  A 3-year follow-up of a multidisciplinary rehabilitation programme for back and neck pain , 2005, Pain.

[43]  E. Keogh,et al.  Do men and women differ in their response to interdisciplinary chronic pain management? , 2005, Pain.

[44]  G. Fairbrother,et al.  Patient characteristics and quality of life among a sample of Australian chronic pain clinic attendees , 2004, Internal medicine journal.