Chronic Pain Management Program Research Articles

Erratum to Vitamin D Deficiency–Associated Neuropathic Pain Examined in a Chronic Pain Management Program

Erratum to Vitamin D Deficiency–Associated Neuropathic Pain Examined in a Chronic Pain Management Program

Social support as a key factor in chronic pain management programs: a scoping review

Social support as a key factor in chronic pain management programs: a scoping review

Vitamin D Deficiency-Associated Neuropathic Pain Examined in a Chronic Pain Management Program.

Vitamin D Deficiency-Associated Neuropathic Pain Examined in a Chronic Pain Management Program.

Identification of Musculoskeletal Health Status, Pain Acceptance, and Coping Strategies in Individuals with Chronic Pain and Physical Disabilities: A Cross-Sectional Comparative Study

Purpose: The purpose of this study is to determine the musculoskeletal health status, pain acceptance, and coping strategies of individuals with chronic pain and physical disabilities and compare them with control group. Material and Methods: This cross-sectional study included a total of 88 participants, divided into two groups: the study group (individuals with chronic pain and physical disabilities; n=44) and the control group (individuals with chronic pain but without disabilities; n=44). Participants' musculoskeletal health was assessed using the Musculoskeletal Health Questionnaire (MHQ), pain acceptance using the Chronic Pain Acceptance Questionnaire (CPAQ), and coping strategies were evaluated using the COPE inventory. Results: Significant differences were observed between the groups in terms of MHQ scores and COPE scores (p0.05). Discussion: This results emphasizes the need for a careful assessment of coping strategies in individuals with chronic pain and physical disabilities in interdisciplinary chronic pain management programs, as well as the inclusion of personalized coping strategies in the intervention program.

Establishing cut-offs for the Pain Self-Efficacy Questionnaire for people living with chronic pain

LAY SUMMARY Cut-offs were established for the Pain Self-Efficacy Questionnaire (PSEQ) by examining it with other clinical measures in 189 patients, including 69 Veterans, who attended a four-week interdisciplinary chronic pain management program. By dividing the PSEQ scores into low, medium, and high ranges, the authors examined the PSEQ’s association with fear of movement/re-injury (kinesiophobia), pain interference, and pain catastrophizing at admission and discharge from the program. Kinesiophobia was found to be most related to the proposed cut-offs. Findings support the use of PSEQ cut-offs when considering self-efficacy and kinesiophobia. Future research should evaluate these cut-offs with larger samples and functional/occupational measures. The findings show promise for individuals with chronic pain and continue to increase the understanding of the clinicians who work with these individuals.

Establishing cut-offs for the Pain Self-Efficacy Questionnaire for people living with chronic pain

LAY SUMMARY Cut-offs were established for the Pain Self-Efficacy Questionnaire (PSEQ) by examining it with other clinical measures in 189 patients, including 69 Veterans, who attended a four-week interdisciplinary chronic pain management program. By dividing the PSEQ scores into low, medium, and high ranges, the authors examined the PSEQ’s association with fear of movement/re-injury (kinesiophobia), pain interference, and pain catastrophizing at admission and discharge from the program. Kinesiophobia was found to be most related to the proposed cut-offs. Findings support the use of PSEQ cut-offs when considering self-efficacy and kinesiophobia. Future research should evaluate these cut-offs with larger samples and functional/occupational measures. The findings show promise for individuals with chronic pain and continue to increase the understanding of the clinicians who work with these individuals.

Experiences of Veteran and Civilian Patients in Exploratory Yoga Sessions for Chronic Pain: A Qualitative Study

ABSTRACT Background Yoga integrates all aspects of self, with biological, mental, intellectual, and spiritual elements. The practice of yoga aligns with the biopsychosocial model of health and, as such, it can be instrumental in pain treatment. Aims The purpose of this qualitative study was to explore perceptions regarding the yoga sessions for chronic pain through thematic content analysis with comparison of gender, veteran or civilian status, and delivery methods. Methods Patients with chronic pain attended a 5-week intensive interdisciplinary chronic pain management program at the Michael G. DeGroote Pain Clinic. Participants were asked to complete six open-ended questions following four weekly 1-h yoga classes, through in-person or virtual delivery. Survey responses were thematically and separately analyzed by reviewers. Results Forty-one (N = 41) participants (56% males, 71% veterans) with an average age of 50.87 (SD 10.10) years provided comments. Nine themes emerged: (1) mind and body are one through yoga practices; (2) meaningful practice of yoga basics is productive for range of motion/movement, tension in joints, and chronic pain; (3) yoga classes provide an enjoyable process of learning; (4) yoga reminds patients of their physical capabilities; (5) routine practices lead to improvements; (6) yoga improved on strategies for chronic pain; (7) yoga can be adapted for each patient; (8) mindset improves to include positive thinking, better focus, and willingness to try new things; and (9) improvements exist for the current yoga programming. Conclusion Findings of the current study were nine qualitative themes that present the experience of patients with chronic pain in the yoga sessions.

Assessing the feasibility of a clinical trial to evaluate an advanced practice physiotherapy model of care in chronic pain management: a feasibility study

BackgroundChronic pain management is challenging for health systems worldwide. Clinical practice guidelines recommend interprofessional chronic pain management, but chronic pain clinics often have lengthy wait-lists. Advanced practice physiotherapists (APP) in orthopedic clinics and emergency departments have provided effective care and reduced wait times. The purpose of this study is to determine the feasibility of a clinical trial to evaluate the effects of integrating an APP into a chronic pain clinic setting. The primary objectives are as follows: (1) determine the feasibility of implementing trial methods by evaluating participant recruitment rates, retention, and assessment completion; (2) determine the feasibility of implementing the APP model of care by monitoring care provided and treatment fidelity; and (3) assess contextual factors that may influence implementation of the APP model of care by exploring the perspectives of patient participants and healthcare providers related to the model of care.MethodsThis will be a single-arm feasibility study with embedded qualitative interviews to assess contextual factors influencing implementation by exploring participant and provider perspectives. Approximately 40 adults with chronic musculoskeletal pain referred for care at an interprofessional chronic pain clinic will be invited to participate in the feasibility study. Approximately 10–12 patient participants and 5–10 health professionals from the interprofessional team will be interviewed using an interpretive description approach. The APP model of care will involve participants seeing a physiotherapist as the first point of contact within the interprofessional team. The APP will complete an initial assessment and make care recommendations. Outcome measures planned for the full trial will be reported descriptively, including pain severity, pain interference, health-related quality of life, psychosocial risk factors for chronic pain, treatment satisfaction, perceived change, healthcare utilization, and healthcare costs over one year.DiscussionThis study will inform plans to implement a full-scale study to evaluate the impact of an APP model of care in an interprofessional chronic pain management program. The results of the full study are intended to inform stakeholders considering this model to improve patient-centered and health system outcomes in interprofessional pain management program settings.Trial registrationClinicalTrials.gov, NCT05336903 (Registered April 5, 2022).

Empower Veterans Program (EVP): a chronic pain management program demonstrates positive outcomes among veterans

BackgroundChronic pain is a highly prevalent health condition among veterans. Traditional pharmacological interventions present unique challenges for chronic pain management including prescription opioid addiction and overdose. In alignment with the 2016 Comprehensive Addiction and Recovery Act and VA’s Stepped Care Model to meet veterans’ pain management needs, the Offices of Rural Health and Pain Management, Opioid Safety, and Prescription Drug Monitoring Program (PMOP) funded an enterprise-wide initiative to implement a Step 3 integrated tele-pain program: Empower Veterans Program (EVP). EVP provides veterans with chronic pain self-care skills using a whole health driven approach to pain management.ObjectivesThe Comprehensive Addiction and Recovery Act prompted the strategic approach to offer non-pharmacological options to meet veterans’ pain management needs. EVP, a 10-week interdisciplinary group medical appointment, leverages Acceptance and Commitment Therapy, Mindful Movement, and Whole Health to provide veterans with chronic pain self-care skills. This evaluation was conducted to describe participant characteristics, graduation, and satisfaction rates; and assess pre-post patient-reported outcomes (PRO) associated with EVP participation.MethodsA sample of 639 veterans enrolled in EVP between May, 2015 and December, 2017 provided data to conduct descriptive analyses to assess participant demographics, graduation, and satisfaction rates. PRO data were analyzed using a within-participants pre-post design, and linear mixed-effects models were used to examine pre-post changes in PRO.ResultsOf 639 participants, 444 (69.48%) graduated EVP. Participant median program satisfaction rating was 8.41 (Interquartile Range: 8.20–9.20). Results indicate pre-post EVP improvements (Bonferroni-adjusted p < .003) in the three primary pain outcomes (intensity, interference, catastrophizing), and 12 of 17 secondary outcomes, including physical, psychological, health-related quality of life (HRQoL), acceptance, and mindfulness measures.DiscussionData suggest that EVP has significant positive outcomes in pain, psychological, physical, HRQoL, acceptance, and mindfulness measures for veterans with chronic pain through non-pharmacological means. Future evaluations of intervention dosing effect and long-term effectiveness of the program is needed.

Neurocognitive predictors of adherence to an online pain self-management program adjunct to long-term opioid therapy

ABSTRACT Introduction While pain self-management programs can significantly improve patient outcomes, poor adherence is common and the need for research on predictors of adherence has been noted. A potential, but commonly overlooked, predictor is cognitive function. Our aim, then, was to examine the relative influence of various cognitive functional domains on engagement with an online pain self-management program. Method A secondary analysis of a randomized controlled trial testing the impact of E-health (a 4-month subscription to the online Goalistics Chronic Pain Management Program) plus treatment as usual, relative to treatment as usual alone, on pain and opioid dose outcomes in adults receiving long-term opioid therapy of morphine equivalence dose ≥20 mg; 165 E-health participants who completed an on-line neurocognitive battery were included in this sub-analysis. A variety of demographic, clinical, and symptom rating scales were also examined. We hypothesized that better processing speed and executive functions at baseline would predict engagement with the 4-month E-health subscription. Results Ten functional cognitive domains were identified using exploratory factor analysis and the resultant factor scores applied for hypothesis testing. The strongest predictors of E-health engagement were selective attention, and response inhibition and speed domains. An explainable machine learning algorithm improved classification accuracy, sensitivity, and specificity. Conclusions The results suggest that cognition, especially selective attention, inhibitory control, and processing speed, is predictive of online chronic pain self-management program engagement. Future research to replicate and extend these findings seems warranted. ClinicalTrials.gov Registration Number NCT03309188

Feasibility of Mindfulness-Based Intervention for Veterans Managing Chronic Pain.

Background. Chronic pain impacts people's activity participation, productivity, mental health, and sense of wellbeing. Purpose. This study aimed to (1) evaluate the feasibility of the Mindfulness-Based Chronic Pain Management (MBCPMTM) program on reducing pain perception and enhancing the quality of life, and (2) understand veterans' experience with the program. Method. The pretest-posttest single-group, mixed-methods design was used. Thirty-one veterans were offered the 12-week intervention. The Pain Catastrophizing Scale (PCS) and the Patient-Reported Outcomes Measurement Information System-29 were administered before and after the program. Focus groups and individual interviews were conducted to understand the experience. Findings. Participants' PCS scores improved (Z = -3.116, p = .002), but the pain intensity did not change significantly. Themes from qualitative data include: (1) We are not alone! (2) I have a sense of awareness, choices, and control; and (3) It does work! Implications. The study shows preliminary feasibility of MBCPMTM for veterans. This promising effect supports future rigorous testing of this intervention.

The use of wearable technology in a comprehensive chronic pain management programme

Technology is increasingly used to promote physical activity and reduce sedentary behaviour in the general population, but the possibility of using it to support physical activity in chronic pain patients is still sparse. Physical activity is crucial for improving quality of life of chronic pain patients. However, long-term physical activity goals widely depend on pain perception, actual or anticipated pain exacerbation, and lack of confidence when doing physical activity. We aimed to determine whether wearable technology can improve management of chronic pain. Full protocol of this 8-week clinical trial is available in the Clinical Trials Registry (NCT 03837080). In short, chronic pain patients enrolled in the 4-week multidisciplinary chronic pain management programme wore fitness wristbands during the 4-week programme (0-4 weeks) and during the follow-up (4-8 weeks). Fitness wristbands measured physical activity and sleep patterns. Additionally, anthropometric measurements and psychological condition of patients (by using Pain Catastrophizing Scale and Depression, Anxiety and Stress Scale – 21 Items questionnaires) was measured. The number of steps and average time of activity per day increased, as well as deep sleep time per day but without reaching statistical significance. Significant improvements in waist circumference and waist-to-hip ratio and waist-to-height ratio with longer deep sleep time were found. No significant correlation was found between physical activity, sleep quality and psychological characteristics or catastrophizing. By wearing fitness wristbands, patients feel actively involved in their chronic pain management. In a clinical/research setting, wristbands provide better, continuous oversight of patient’s progress end enables tailoring of individualized strategies. However, the use of wristbands requires some level of IT knowledge, and sudden malfunctions of the wristband and/or the software can be expected. Additionally, some individual characteristics (i.e., demographics, psychosocial factors, lack of motivation) can also be obstacles to their use.

The use of wearable technology in a comprehensive chronic pain management programme

Technology is increasingly used to promote physical activity and reduce sedentary behaviour in the general population, but the possibility of using it to support physical activity in chronic pain patients is still sparse. Physical activity is crucial for improving quality of life of chronic pain patients. However, long-term physical activity goals widely depend on pain perception, actual or anticipated pain exacerbation, and lack of confidence when doing physical activity. We aimed to determine whether wearable technology can improve management of chronic pain. Full protocol of this 8-week clinical trial is available in the Clinical Trials Registry (NCT 03837080). In short, chronic pain patients enrolled in the 4-week multidisciplinary chronic pain management programme wore fitness wristbands during the 4-week programme (0-4 weeks) and during the follow-up (4-8 weeks). Fitness wristbands measured physical activity and sleep patterns. Additionally, anthropometric measurements and psychological condition of patients (by using Pain Catastrophizing Scale and Depression, Anxiety and Stress Scale – 21 Items questionnaires) was measured. The number of steps and average time of activity per day increased, as well as deep sleep time per day but without reaching statistical significance. Significant improvements in waist circumference and waist-to-hip ratio and waist-to-height ratio with longer deep sleep time were found. No significant correlation was found between physical activity, sleep quality and psychological characteristics or catastrophizing. By wearing fitness wristbands, patients feel actively involved in their chronic pain management. In a clinical/research setting, wristbands provide better, continuous oversight of patient’s progress end enables tailoring of individualized strategies. However, the use of wristbands requires some level of IT knowledge, and sudden malfunctions of the wristband and/or the software can be expected. Additionally, some individual characteristics (i.e., demographics, psychosocial factors, lack of motivation) can also be obstacles to their use.

Evolution of a chronic pain management program in a Northwestern Ontario community: from structural elements to practical application

BackgroundChronic pain is a highly prevalent health problem especially in rural regions. There is a dearth of comprehensive pain management programs particularly in rural areas.AimThe objectives of this paper are to describe the evolution of an interprofessional chronic pain team employing a patient-centered model of care with a biopsychosocial approach, and health services metrics.MethodThis descriptive case study approach includes an overview of the Chronic Pain Management Program (CPMP) services at St. Joseph Care Group in Thunder Bay, NW Ontario; the process involved in the development of an interprofessional chronic pain team employing a patient-centered model of care with a biopsychosocial approach; and metrics of the program’s operations.ResultsEstablished in 1998, CPMP has evolved to become inter-professional, providing consultations and management, with partial funding by the Ontario Ministry of Health and Long term Care that has allowed expansion of services. The CPMP currently provides three distinct program streams as follows: a) Intensive 6-week, four half-days/week, outpatient program that offers an interdisciplinary team approach in groups and individual format; b) PACE-IT (Pain Assessment Collaborative Education Inter-professional Therapy), 8-week long, half-day/ week, interprofessional treatment program, in person; and c) Individual format for one-on-one services for patients not fitting in either the 6-Week or PACE-IT programs. In addition, Additional services provide virtual consultations and didactic videoteleconference sessions on opioid stewardship and pain management to health providers. Health services outcomes, research, and educational opportunities across the Northwestern Ontario Region, challenges and future needs are discussed.ConclusionThe CPMP’s model of care can serve as a foundation for expert chronic pain care delivery across rural Canada, and as template for similar institutionally-based and publicly funded pain clinics.

Postural Orthostatic Tachycardia Syndrome (POTS): Characteristics of Youth Enrolled in an Outpatient Interdisciplinary Pediatric Chronic Pain Program

Postural Orthostatic Tachycardia Syndrome (POTS) is a common form of orthostatic intolerance that affects about 3,000,000 people in the United States. For youth, significant functional impairment is noted, especially related to school attendance, limited participation in social and physical activities, and lower quality of life. Although previous research highlights the unique challenges for youth with chronic pain, fewer studies have focused on the clinical presentation of pediatric patients with POTS. This study aimed to explore characteristics of youth with POTS presenting to an interdisciplinary pediatric chronic pain program. Twenty-nine adolescents (14.7 +/- 1.7 years; 79% female) diagnosed with POTS presenting with their caregiver to an initial visit at an interdisciplinary pediatric chronic pain management program at a large Northeastern children's hospital in the United States were asked to complete questionnaires assessing demographic and pain characteristics, pain acceptance, and functional impairment and anxiety (PROMIS; t-scores). Number of visits within the program were gathered from medical record. Youth were primarily Caucasian/White (86.2%), Other (6.9%), AAPI (3.4%) and Mixed Race (3.4%). Youth reported overall low pain acceptance (M=34.1, SD=9.3), moderate anxiety (M=57.1, SD=13.1) and high pain interference (M=63, SD =7.4). Caregivers reported observing moderate anxiety (M=59.1, SD =11.5) and high pain interference (M=65.1, SD=4.6) for youth. Adolescents were observed to attend a wide range of visits within the program, including medical (1.7 +/- 2.5), physical therapy (3.4 +/- 4.9), occupational therapy (.5 +/- 1.7), and psychology (4.3 +/- 3.6). Less is known about youth with POTS who present for treatment. Additionally, youth with POTS meet with multiple doctors before receiving a diagnosis leading to disparities in access to treatment and the type of treatment that is received. Data here highlights that youth with POTS are experiencing significant impairment and more research targeting this population is necessary to improve outcomes. Postural Orthostatic Tachycardia Syndrome (POTS) is a common form of orthostatic intolerance that affects about 3,000,000 people in the United States. For youth, significant functional impairment is noted, especially related to school attendance, limited participation in social and physical activities, and lower quality of life. Although previous research highlights the unique challenges for youth with chronic pain, fewer studies have focused on the clinical presentation of pediatric patients with POTS. This study aimed to explore characteristics of youth with POTS presenting to an interdisciplinary pediatric chronic pain program. Twenty-nine adolescents (14.7 +/- 1.7 years; 79% female) diagnosed with POTS presenting with their caregiver to an initial visit at an interdisciplinary pediatric chronic pain management program at a large Northeastern children's hospital in the United States were asked to complete questionnaires assessing demographic and pain characteristics, pain acceptance, and functional impairment and anxiety (PROMIS; t-scores). Number of visits within the program were gathered from medical record. Youth were primarily Caucasian/White (86.2%), Other (6.9%), AAPI (3.4%) and Mixed Race (3.4%). Youth reported overall low pain acceptance (M=34.1, SD=9.3), moderate anxiety (M=57.1, SD=13.1) and high pain interference (M=63, SD =7.4). Caregivers reported observing moderate anxiety (M=59.1, SD =11.5) and high pain interference (M=65.1, SD=4.6) for youth. Adolescents were observed to attend a wide range of visits within the program, including medical (1.7 +/- 2.5), physical therapy (3.4 +/- 4.9), occupational therapy (.5 +/- 1.7), and psychology (4.3 +/- 3.6). Less is known about youth with POTS who present for treatment. Additionally, youth with POTS meet with multiple doctors before receiving a diagnosis leading to disparities in access to treatment and the type of treatment that is received. Data here highlights that youth with POTS are experiencing significant impairment and more research targeting this population is necessary to improve outcomes.

The Uptake and Effectiveness of a Multidisciplinary Online Program for Managing Chronic Pain before and During the COVID-19 Pandemic

ObjectivesSocietal and health system pressures associated with the coronavirus disease 2019 (COVID-19) pandemic exacerbated the burden of chronic pain and limited access to pain management services for many. Online multidisciplinary pain programs offer an effective and scalable treatment option, but have not been evaluated within the context of COVID-19. This study aimed to investigate the uptake and effectiveness of the Reboot Online chronic pain program before and during the first year of the COVID-19 pandemic.MethodsRetrospective cohort analyses were conducted on routine service users of the Reboot Online program, comparing those who commenced the program during the COVID-19 pandemic (March 2020–March 2021), to those prior to the pandemic (April 2017–March 2020). Outcomes included the number of course registrations; commencements; completion rates; and measures of pain severity, interference, self-efficacy, pain-related disability, and distress.ResultsData from 2,585 course users were included (n = 1138 pre-COVID-19 and n = 1,447 during-COVID-19). There was a 287% increase in monthly course registrations during COVID-19, relative to previously. Users were younger, and more likely to reside in a metropolitan area during COVID-19, but initial symptom severity was comparable. Course adherence and effectiveness were similar before and during COVID-19, with moderate effect size improvements in clinical outcomes post-treatment (g = 0.23–0.55).DiscussionUptake of an online chronic pain management program substantially increased during the COVID-19 pandemic. Program adherence and effectiveness were similar pre- and during-COVID. These findings support the effectiveness and scalability of online chronic pain management programs to meet increasing demand.

An interdisciplinary program for familiar faces with chronic pain visiting the emergency department-randomized controlled trial.

ObjectivesTo evaluate the effect of a collaborative interdisciplinary pain assessment program on pain and health‐related quality of life among individuals with chronic pain who frequently visit the emergency department (ED).MethodsIndividuals with chronic pain who frequented the ED (ie, ≥8 visits within the previous 12 months) were randomly assigned to a collaborative chronic pain management program or treatment as usual. Primary outcomes were change in physical function and visits to the ED from baseline to 12 months using validated measures. Secondary measures included physical and emotional functioning, insomnia, health‐related quality of life, risk of aberrant opioid use, and health care use. Mixed model analyses of variances were used to evaluate intervention effectiveness among the whole sample (ie, using intention to treat principles) and individuals who completed more than 50% of follow‐up assessments.ResultsOne hundred participants were assessed for eligibility and 46 patients were enrolled with 24 being randomized to intervention and 22 to treatment as usual (TAU). Eleven of the 24 patients randomized to the intervention were lost to follow‐up and 3 withdrew participation. Two of the 22 patients randomized to TAU were lost to follow‐up, and 7 withdrew. Although patients assigned to the intervention improved more rapidly on measures of pain and health related quality of life, both groups had similar improvements overall between baseline to 12 months. Average pain intensity reduction (numeric rating scale [SE]) was 4.63 (0.40) in the intervention and 4.82 (0.53) in the treatment as usual at the 12‐month follow‐up. A significant group × time interaction was present for risk of aberrant opioid use, with individuals in the intervention group reporting greater improvement in risk of aberrant opioid use by 12‐month follow‐up.ConclusionParticipation in an interdisciplinary program may accelerate improvements in pain‐ and health‐related quality of life and reduce risk of aberrant opioid use to manage pain and related distress. Further research is needed to better understand and address barriers to engagement in chronic pain care.

Exploring patients’ perceptions of outcome measures after completing a pain management programme: A qualitative study

Purpose: Introduction: Patient-reported outcome measures are commonly used within healthcare to measure individual's perceptions of functional ability and psychological wellbeing. Such measures are widely used within the chronic pain and pain management programme (PMP) setting (Guildford et al., 2017) . Clinical guidelines for PMP's encourage the collection of such measures. In addition to capturing change in individuals, they are useful for evaluating the success of services, guiding resource allocation and demonstrating the value of the treatment intervention (BPS Guidelines, 2013) .

Assessing the fidelity of a peer-led chronic pain management program (PAP)

BackgroundIntervention fidelity is the core component of a well-designed clinical trial and processes that are used to ensure that the study intervention is delivered as planned. It affects the design and implementation of a study as well as the analysis of the results and interpretation of the findings. The objectives of this study are (a) to describe the methods of assessing the intervention fidelity used in the peer-led chronic pain management program (PAP) and (b) to report the findings on the PAP’s intervention fidelity.MethodsTo optimize fidelity to the intervention, we used various strategies and measured them in a continuous process using several different approaches: (a) peer volunteer (PV) training workshop, (b) biweekly meetings with the research team, (c) a detailed teaching manual, (d) a fidelity checklist, (e) on-site visits and direct observations, and (f) semi-structured interview.ResultsThe PVs’ attendance was high, and most of them achieved a high level of implementation in following the fidelity checklist. As part of a large clustered RCT, the fidelity assessment was carried out to help determine the effectiveness of the intervention.ConclusionsOverall, the PVs successfully delivered the intervention, and the results of the study indicate the effectiveness of the PAP.Trial registrationClinicalTrials.govNCT03823495. Registered on 30 January 2019.

Development of an interdisciplinary specialist facial pain management programme.

This article aims to describe the development of a specialist chronic facial pain (CFP) management programme within an already well-established pain management service, including the content from a multidisciplinary perspective, and present preliminary descriptive 6-month outcomes from patients who have attended the programme. Authors used their clinical experience of working with people who have a diagnosis of CFP. They researched available literature, liaised with CFP support organisations and visited an existing UK-based CFP programme. Programme content was designed based on findings. The roles of pain interdisciplinary team members involved in delivering the programme are described, as well as a brief description of the structure of the programme and programme sessions provided by each discipline. Clinical outcomes from programme participants were collected at assessment, end of treatment and 6 months post-treatment, which measured relevant outcomes for a pain management programme (PMP). Outcomes from 36 participants at both end of programme and 6 months following completion of programme demonstrate promising improvements. Qualitative data from patient satisfaction questionnaires completed at the end of programme suggest that providing a CFP-specific programme was beneficial for participants, with the main critique being that the programme sessions should be longer than 45 minutes. Attending a CFP-specific programme demonstrated positive 6-month changes in relevant outcome measures for people with CFP. With a small sample size, there is a need for further research into the effectiveness. It would also be beneficial to compare outcomes from the usual PMP treatment with people who have CFP, with outcomes from a CFP-specific programme.