(106) Pain Intensity as a Lagging Indicator of Patient Improvement: Longitudinal Relationships with Sleep, Mood, and Function in Multidisciplinary Care

Abstract

Patients and many providers assume that chronic pain intensity must be reduced before improvements in other patient reported outcomes such as mood and function are possible. However, there has been relatively little empirical inquiry into the temporal ordering of improvements in chronic pain treatment. It is unclear whether improvements in other domains are likely to emerge earlier in multidisciplinary care or their consequent implications for pain relief. The current study sought to examine these questions in patients presenting for chronic pain specialty care using data from PainTracker, a patient-reported outcome-tracking tool at the University of Washington Center for Pain Relief. We examined patient outcomes in 6 domains: average pain intensity, difficulties with initiating and maintaining sleep, depressive and anxious symptoms, and self-rated physical disability in a sample of 665 patients with chronic pain who demonstrated improvement in pain intensity (≥ 1 point reduction on 0-10 numeric rating scale) during their pain care. Data were drawn from a 1-year period beginning at initial presentation to the clinic to estimate cross-lagged longitudinal path models examining the relative size of relationships between pain intensity and other outcomes. Results indicated that improvements in pain and other outcomes followed similar trajectories across time. However, cross-lagged model analyses concerning relationships among outcomes indicated that all non-pain outcomes significantly predicted later pain intensity scores, whereas pain intensity predicted only sleep outcomes at a follow-up clinic visit. Our results provide preliminary evidence that reductions in pain intensity may not need to be the first step in patient improvement. In our analyses, pain improvement did not predict improvement in other outcomes. Indeed, improvements in mood, sleep, and function were stronger predictors of pain relief than vice-versa. Future studies may benefit from structured data collection and uniform interventional approaches to replicate and extend the current findings.