Improvements in objective and subjective functioning following completion of an interdisciplinary pain rehabilitation program

Abstract

The benefits of interdisciplinary pain programs are well documented; however, coverage is denied by many payer systems. Further data are warranted to expand the evidence for such positive treatment outcomes. The present study examined outcome data for 75 patients who completed a four-week residential pain rehabilitation program. The program consists of appropriate medication adjustment (not necessarily opioid withdrawal), education, relaxation training, counseling, biofeedback, and physical therapy. Average age was 43.28 years (SD=9.25) with an average duration of 57.46 months from injury to program entry. The sample was 57.3% female and 86.3% Caucasian. Pre- to post-treatment outcomes were analyzed with repeated measures design. Results revealed significant reductions in psychological distress (e.g., Pain Anxiety Symptoms Scale; p<0.001, and Beck Depression Inventory; p<0.001, among others) and increase in pain acceptance (Chronic Pain Acceptance Questionnaire; p<0.001). Self-reported pain intensity significantly decreased (Numerical Rating Scale; p<0.001) and perceived functional impairment decreased (Oswestry Activity Rating Scale; p<0.001). Improvements in functional measures were also noted, including trunk range of motion (e.g., forward flexion, extension, etc.; all p<0.001) and timed 100 yard walk (p<0.001). Exercise tolerance increased by an average of 13.28% (SD=14.10). The majority of these effects were of moderate size (mean partial η2 = .47). Patients reported significant satisfaction at discharge, including improvements in mood (M=46.79%, SD=33.31), activity level (M=51.89%, SD=31.38), social interactions (M=37.29%, SD=34.47), coping self-efficacy (M=50.08%, SD=33.61), and pain intensity (M=25.32%, SD=27.79). It is interesting to note that significant psychological, pain, and functional improvements were observed, despite starting treatment on average almost 5 years post-injury and despite relatively stable medication dosing (i.e., there was a trend toward decreased morphine equivalent doses of opioid analgesics, p=0.06). This analysis provides further evidence that an interdisciplinary rehabilitation program can result in significant improvements in both subjective and objective functioning, independent of medication use and time since injury. The benefits of interdisciplinary pain programs are well documented; however, coverage is denied by many payer systems. Further data are warranted to expand the evidence for such positive treatment outcomes. The present study examined outcome data for 75 patients who completed a four-week residential pain rehabilitation program. The program consists of appropriate medication adjustment (not necessarily opioid withdrawal), education, relaxation training, counseling, biofeedback, and physical therapy. Average age was 43.28 years (SD=9.25) with an average duration of 57.46 months from injury to program entry. The sample was 57.3% female and 86.3% Caucasian. Pre- to post-treatment outcomes were analyzed with repeated measures design. Results revealed significant reductions in psychological distress (e.g., Pain Anxiety Symptoms Scale; p<0.001, and Beck Depression Inventory; p<0.001, among others) and increase in pain acceptance (Chronic Pain Acceptance Questionnaire; p<0.001). Self-reported pain intensity significantly decreased (Numerical Rating Scale; p<0.001) and perceived functional impairment decreased (Oswestry Activity Rating Scale; p<0.001). Improvements in functional measures were also noted, including trunk range of motion (e.g., forward flexion, extension, etc.; all p<0.001) and timed 100 yard walk (p<0.001). Exercise tolerance increased by an average of 13.28% (SD=14.10). The majority of these effects were of moderate size (mean partial η2 = .47). Patients reported significant satisfaction at discharge, including improvements in mood (M=46.79%, SD=33.31), activity level (M=51.89%, SD=31.38), social interactions (M=37.29%, SD=34.47), coping self-efficacy (M=50.08%, SD=33.61), and pain intensity (M=25.32%, SD=27.79). It is interesting to note that significant psychological, pain, and functional improvements were observed, despite starting treatment on average almost 5 years post-injury and despite relatively stable medication dosing (i.e., there was a trend toward decreased morphine equivalent doses of opioid analgesics, p=0.06). This analysis provides further evidence that an interdisciplinary rehabilitation program can result in significant improvements in both subjective and objective functioning, independent of medication use and time since injury.