Abstract
BackgroundChronic painful conditions have an important influence on the ability to work. Work-related outcomes, however, are not commonly reported in publications on trials investigating the treatment of chronic painful conditions. We aim to provide an overview of the reporting of work-related outcomes in such trials and investigate the relationship between work-related outcomes and pain outcomes.MethodsWe conducted a systematic literature search in PubMed with the aim of identifying randomised placebo-controlled clinical trials investigating treatments for chronic painful conditions or rheumatic diseases that also reported on work-related outcomes. Methodological study quality was assessed with the Oxford Quality Scale (OQS). Meta-analyses were conducted for the outcomes of interference with work and number of patients with at least 30% reduction in pain intensity (30% pain responders). The correlation between work-related and pain outcomes was investigated with regression analyses.ResultsWe included 31 publications reporting on 27 datasets from randomised placebo-controlled trials (with a total of 11,434 study participants) conducted in chronic painful or rheumatic diseases and reporting on work-related outcomes. These 31 publications make up only about 0.2% of all publications on randomised placebo-controlled trials in such conditions. The methodological quality of the included studies was high; only nine studies scored less than four (out of a maximum five) points on the OQS. Sixteen different work-related outcomes were reported on in the studies. Of 25 studies testing for the statistical significance of changes in work-related outcomes over the course of the trials, 14 (56%) reported a significant improvement; the others reported non-significant changes. Eight studies reported data on both interference with work and 30% pain responders: meta-analyses demonstrated similar, statistically significant improvements in both these outcomes with active therapy compared to placebo and regression analysis showed that these outcomes were correlated.ConclusionsDespite the importance of pain as a reason for decreased ability to work, work-related outcomes are reported in substantially less than 1% of publications on placebo-controlled trials in chronic painful and rheumatic diseases. Work-related outcomes and pain responder outcomes are closely related.
Highlights
Chronic painful conditions have an important influence on the ability to work
Because for pain intensity the reporting as ‘responder outcomes’, such as the proportion of study participants experiencing at least 30%, or 50%, reduction in pain intensity over the course of a trial (30% or 50% pain responders), is more informative than treatment group average data, we focus on pain responder outcomes; this is in agreement with recent guidance on performing systematic reviews in the chronic pain field [5]
To estimate the total number of publications that could potentially have reported on work-related outcomes, we performed our search without the work-related terms
Summary
Chronic painful conditions have an important influence on the ability to work. Work-related outcomes, are not commonly reported in publications on trials investigating the treatment of chronic painful conditions. Chronic painful conditions are very common as a recent systematic review of prevalence studies has demonstrated [1]. Patients affected by a chronic painful disease experience the adverse effects of their condition on a number of domains of life, including work. In different studies 13% to 76% of chronic pain patients experienced loss of employment or were unable to undertake employment [1]. Those with moderate and, especially, severe pain are affected [3]. It would be informative to know how work ability is affected by common pain treatments
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