Clinical outcomes measurement: Patient centered success criteria and expectations for treatment: A comparison of spine pain and facial pain patients

Abstract

Although the patient-centered model of health care delivery has been adopted as a goal of clinical medicine, there have been few patient-centered investigations of treatment outcome for chronic pain. Most of these investigations have focused exclusively on pain reduction, although patients may benefit from improvements in other domains (e.g., mood, functioning). The present study aims to expand on previous research using our Patient Centered Outcomes (PCO) Questionnaire by examining potential differences between spine pain patients and facial pain patients in their success criteria and expectations for treatment. The PCO Questionnaire assesses four domains: pain, fatigue, emotional distress, and interference with daily activities. For each domain, usual level during the past week, as well as desired, expected, and minimally successful levels following treatment are measured on 11-point numerical rating scales (NRS; 0 = none, 10 = worst imaginable). Preliminary data on 82 female patients (35 spine pain, 47 facial pain) revealed higher usual levels of fatigue, distress, and interference in spine pain patients (p<.05). The two patient groups reported comparable usual levels of pain. ANOVAs showed no significant differences between spine pain patients and facial pain patients with respect to absolute success criteria for pain (2.6 v. 2.2, respectively), fatigue (2.5 v. 2.1), distress (1.9 v. 1.9), and interference (1.9 v. 1.6). However, given that spine pain patients begin treatment with higher levels of distress and interference than facial pain patients, they require greater reductions in these domains for treatment to be successful (ps<.01). Finally, analyses revealed that both spine pain patients and facial pain patients generally expect treatment to produce successful outcomes across the four domains, with the exception that spine pain patients do not expect treatment to produce successful results for the domain of interference (p<.01). Evaluation of existing treatment outcome investigations and treatment matching will be discussed.