Abstract
This study investigates the effects of sex, education, and country of birth on clinical presentations and outcomes of interdisciplinary multimodal pain rehabilitation programs (IMMRPs). A multivariate improvement score (MIS) and two retrospective estimations of changes in pain and ability to handle life situations were used as the three overall outcomes of IMMRPs. The study population consisted of chronic pain patients within specialist care in the Swedish Quality Registry for Pain Rehabilitation (SQRP) between 2008 and 2016 at baseline (n = 39,916), and for the subset participating in IMMRPs (n = 14,666). A cluster analysis based on sex, education, and country of origin revealed significant differences in the following aspects: best baseline clinical situation was for European women with university educations and the worst baseline clinical situation was for all patients born outside Europe of both sexes and different educations (i.e., moderate-large effect sizes). In addition, European women with university educations also had the most favorable overall outcomes in response to IMMRPs (small effect sizes). These results raise important questions concerning fairness and equality and need to be considered when optimizing assessments and content and delivery of IMMRPs for patients with chronic pain.
Highlights
20% of the European population has a significant chronic pain condition [1]
There were 39,916 chronic pain patients registered in the Swedish Quality Registry for Pain Rehabilitation (SQRP) database and most patients (76.3%) were women [26]
14,666 patients participated and completed the SQRP questionnaire before and on at least one of the two time points after the Interdisciplinary multimodal pain rehabilitation programs (IMMRPs) [22]; 60% of the patients answering the questionnaires pre-IMMRP and post-IMMRP answered the questionnaires at the 12-month follow-up
Summary
20% of the European population has a significant chronic pain condition [1]. Since chronic pain conditions are associated with increased psychological distress, poor health, sick leave, and high socioeconomic costs [5], a biopsychosocial approach is the foundation of modern clinical pain care and research [6]. IMMRPs, including those in Sweden, are most often psychologically-based interventions (generally, cognitive behavioral therapy (CBT) and often third wave CBT, i.e., acceptance and commitment therapy (ACT)). These treatments include group activities such as chronic pain education, supervised physical activity, and activity training coordinated by an interdisciplinary team [9,10,11,12]. In some of the analyses, this variable was dichotomized as from Europe and outside Europe, labelled as “outside Europe”.
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