Prognostic Factors for Pain Relief and Functional Improvement in Chronic Pain After Inpatient Rehabilitation

Abstract

To determine the factors associated with pain relief and improved physical functioning in chronic pain patients during outpatient management in the first 5 months immediately after a standardized inpatient pain management program. Prospective cohort study using standardized questionnaires on sociodemographic data, disease outcome, psychosocial factors, change in behavior, and outpatient therapies on discharge from inpatient rehabilitation and during the 5-month follow-up at home (observation period). Stepwise forward multivariate linear regression analysis examined the correlation of these factors with change in pain severity and change in physical functioning. The study included 80.1% female patients, 90.0% had at least 1 comorbidity and 62.9% had chronic pain for≥5 years. On average, pain intensity and depression worsened slightly during the observation period, but the other outcomes remained almost stable. Relief from anxiety (20.7% explained variance) and low baseline depression (5.5%) were the most important predictors for pain relief. Relief from anxiety (13.3%) and low baseline depression (7.1%) were most strongly associated with functional improvement. This study found a strong association of change in pain severity and physical functioning with change in baseline level of affective health and coping during the first outpatient management period after inpatient rehabilitation. As a consequence, it may be possible to improve the treatment of chronic pain by therapy of mood and coping.