Abstract
Mechanism-based diagnosis and therapies for chronic pain are lacking. However, bio-psycho-social interventions such as interdisciplinary multimodal rehabilitation programs (IPRPs) have shown to be relatively effective treatments. In this context we aim to investigate the effects of IPRP on the changes in levels of bioactive lipids and telomerase activity in plasma, and if these changes are associated with changes in pain intensity and psychological distress. This exploratory study involves 18 patients with complex chronic pain participating in an IPRP. Self-reports of pain, psychological distress, physical activity, and blood samples were collected before the IPRP and at a six-month follow-up. Levels of arachidonoylethanolamide (AEA) and 2-arachidonoylglycerol (2-AG), palmitoylethanolamide (PEA), oleoylethanolamide (OEA), stearoylethanolamide (SEA), and telomerase activity were measured. Pain intensity was decreased, and SEA levels were increased at the six-month follow up. A significant correlation existed between changes in SEA levels and pain intensity. AEA levels, were inversely correlated with physical activity. Furthermore, 2-AG and telomerase activity was significantly correlated at the six-month follow-up. This study confirms that IPRP is relatively effective for reduction in chronic pain. Changes in SEA were correlated with changes in pain intensity, which might indicate that SEA changes reflect the pain reduction effects of IPRP.
Highlights
Chronic pain is a frequent and distressing condition, often with a complex origin, that has a significant impact on individuals and society
We chose to investigate the long-term effects of interdisciplinary multimodal rehabilitation programs (IPRPs) and the results presented in this work focus on data collected before IPRP and at the six-month follow-up
Six months after attending an IPRP, pain intensity was reduced (p = 0.05) in patients with complex chronic pain: with a moderate Cohen’s d effect size (0.46). This was in line with a large study from the Swedish Quality Registry for Pain Rehabilitation, which reported small to moderate effect sizes for 22 mandatory outcomes, including pain intensity [8], confirming that IPRP have a long-term pain reducing effect for chronic pain patients
Summary
Chronic pain is a frequent and distressing condition, often with a complex origin, that has a significant impact on individuals and society. There are multiple risk factors for developing chronic pain, with female sex and higher age being the fixed risk factors [2], and lack of physical activity a variable risk factor [3]. Interdisciplinary multimodal rehabilitation programs (IPRPs) are frequently used for the treatment of complex chronic pain. In comparison with usual care programs or “single-modal” approaches, IPRP has been reported with higher efficacy in decreasing pain and disability in chronic pain patients, according to systematic reviews [6,7]. These results have been confirmed in a large real-life study from the Swedish Quality Registry for Pain Rehabilitation (SQRP), which reported small to moderate effect sizes for the 22 mandatory outcomes [8]
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