What Is the Effectiveness of Different Duration Interdisciplinary Treatment Programs in Patients with Chronic Pain? A Large-Scale Longitudinal Register Study.

Elena Tseli,Riccardo Lomartire,Linda Vixner,Björn O Äng,Björn Gerdle,Wilhelmus Johannes Andreas Grooten

doi:10.3390/jcm9092788

Abstract

Chronic pain is a leading cause of disability globally. Interdisciplinary multimodal pain rehabilitation (IMPR) targets pain with a bio-psycho-social approach, often delivered as composite programs. However, evidence of optimal program duration for the rehabilitation to succeed remains scarce. This study evaluated the effectiveness of different duration IMPR-programs—using within- and between-effects analyses in a pragmatic multicenter register-based controlled design. Using the Swedish Quality Registry for Pain Rehabilitation, data from fifteen clinics specialized in chronic pain rehabilitation across Sweden were retrieved. Participants were patients with chronic musculoskeletal pain who had taken part in short (4–9 weeks; n = 924), moderate (10 weeks; n = 1379), or long (11–18 weeks; n = 395) IMPR programs. Longitudinal patient-reported outcome data were assessed at baseline, post-intervention, and at a 12-month follow-up. Primary outcomes were health-related quality of life, presented as perceived physical and mental health (SF-36). Secondary outcomes included the Hospital Anxiety and Depression Scale (HADS), pain intensity (NRS 0-10), the Multidimensional Pain Inventory (MPI), and perceived health (EQ-5D). Overall, all groups showed improvements. No clinically important effect emerged for different duration IMPR. In conclusion, while our results showed that patients following IMPR report improvement across a bio-psycho-social specter, a longer program duration was no more effective than a shorter one.

Highlights

Chronic pain, typically defined as pain lasting ≥3 months or beyond the point of normal tissue healing [1], is highly prevalent all over the world and constitutes one of today’s leading public health challenges [2]
Details on the composition of each clinic’s Interdisciplinary multimodal pain rehabilitation (IMPR) program are presently not reported in the Swedish Quality Registry for Pain Rehabilitation (SQRP), when we look to IMPR programs internationally, some variations exist in practice
2698 patients meeting inclusion criteria were referred to IMPR and completed an IMPR program, either a short (n = 924), moderate (n = 1379), or long (n = 395) program at one of the 15 specialist clinics

Summary

Introduction

Typically defined as pain lasting ≥3 months or beyond the point of normal tissue healing [1], is highly prevalent all over the world and constitutes one of today’s leading public health challenges [2]. Chronic pain is often accompanied by a distinctive bio-psycho-social complexity; it negatively affects physical and emotional functioning, social interaction, quality of life, and work ability-resulting in poor overall health [3,4] and disability, as reported in the 2017 Global Burden of Disease study [5]. The IMPR approach adopts a bio-psycho-social perspective and, using the principles of behavioral therapy as a foundation, it incorporates a combination of physical activity/exercise, psychological measures, pharmaceutical treatments, and patient education; all administered by an IMPR team [11] that includes physicians, physiotherapists, occupational therapists, and other health professionals, working closely together using a “shared biopsychosocial model and goals” [6]. IMPR duration, as one dimension of dosage, is certainly complex but the topic has been proposed as a priority research area in pain rehabilitation networks and patient associations. Until now, there has been no available evidence of treatment duration having an influence on the success of the intervention [9]; variations in treatment time between clinical centers are essentially based on local tradition and medical staff preferences—which is the situation currently seen in Sweden

Methods

Results

Discussion

Conclusion