Chronic Pain Management Program Research Articles

Cognitive/behavioral approaches: Providing web-based treatment follow-up for chronic pain management programs: Program development and preliminary usage statistics for the Arthritis Institute Internet Clinic

Cognitive/behavioral approaches: Providing web-based treatment follow-up for chronic pain management programs: Program development and preliminary usage statistics for the Arthritis Institute Internet Clinic

Cognitive/behavioral approaches: Providing web-based treatment follow-up services for chronic pain management programs: Ethical concerns, professional issues and design considerations

Multidisciplinary chronic pain treatment programs teach patients to incorporate symptom-management strategies into their daily routine, including exercise, activity pacing, proper body mechanics, relaxation and cognitive-behavioural strategies for stress and emotional distress. Such programs have been shown to result in decreased pain, disability levels and health care utilization, and improved psychosocial functioning. However, many patients are unable to maintain these significant lifestyle changes long-term. Patients attending our multidisciplinary Rheumatology Day Programs have identified a need for treatment follow-up to facilitate long-term maintenance, but these services are limited due to current staffing constraints. The Arthritis Institute Internet Clinic (AIIC) was proposed as a means to offer novel, cost-effective follow-up treatment through both education and interactive, on-line problem-solving / relapse prevention workshops. This presentation will provide an in-depth examination of the ethical and professional issues involved in providing web-based treatment services. Existing guidelines for web-based health care and research will be reviewed, addressing issues such as the informed consent process, participant privacy and confidentiality, clinician – client communication, and professional accountability. Challenges faced during the program development phase of the AIIC will highlight the fact that development of comprehensive ethical and professional guidelines for web-based treatment and research has not kept pace with rapid advances in the field of e-health. Specific guidelines and practical solutions will be provided for a number of ethical concerns and professional dilemmas faced in the development of the Arthritis Institute Internet Clinic. Future research will examine patients' willingness to use web-based follow-up treatment services, and will determine if web-based treatment follow-up services will result in improved disease management and decreased health care utilization.

Fatigue failure of a shoulder hemiarthroplasty stem: a case report

A 47-year-old right hand–dominant man was seen at the orthopaedic clinic for evaluation of a 3-month history of severe right shoulder pain. Five years earlier, he had undergone a right shoulder hemiarthroplasty for posttraumatic arthritis and malunion after a proximal humerus fracture caused by a motor vehicle accident. After this initial procedure, he had controlled pain and limitation of motion and was involved in a chronic pain management program. Three months earlier, while at a hardware store, he was struck in the right arm by a piece of falling lumber. He had a significant increase in pain at that time; radiographs taken shortly thereafter revealed a fractured humeral prosthesis. Before presentation, he was managed with pain medications but received no definitive treatment. Physical examination revealed a healthy-appearing middle-aged man in no acute distress. Neurologic examination of the upper extremities was unremarkable. There was a well-healed anterior incision over the right shoulder, with a moderate amount of anterior deltoid and rotator cuff atrophy. There was no tenderness to palpation, although he did complain of pain with any movement. Passive rotation of the humerus caused pain and crepitus. Active range of motion consisted of forward elevation to 30°, external rotation to 20°, and internal rotation to the lumbosacral region. There was passive forward elevation to 90° with significant pain. Deltoid strength was 5/5, and external and internal rotation strength was 4/5. Radiographs revealed a fracture of the prosthetic stem at the junction of the proximal and middle thirds (Figure 1). The distal portion was well cemented in place, whereas the proximal part of the prosthesis lacked bony support. The tuberosities were displaced medially, superiorly, and pos-

Impact of Gender, Compensation Status and Chronicity on Treatment Response in Chronic Pain Patients

This archival study examined changes in mood state as a function of gender, compensation status, and chronicity in 162 patients treated in a chronic pain management program. Patients with chronic pain were administered the Profile of Mood States (POMS) as part of pre and post-intervention psychological evaluations. Repeated Measures Analysis of Variance demonstrated that females reported greater improvement in Total Mood Disturbance Scores after treatment than males, even after the effects of compensation status were controlled. Subtest scores also differed significantly between males and females, for both pre- and post-treatment POMS subtest scores. No main effects or interactions were found for chronicity. We hypothesize that the observed sex differences may be due to changes in role functioning, which may be less acceptable to males, or that males who present for treatment represent a more emotionally disturbed subset of men with chronic pain.

Problem-Solving Appraisal and Psychological Adjustment of Persons with Chronic Low-Back Pain

To examine the role of self-appraised problem-solving ability in the prediction of psychosocial impairment, depression, hopelessness, average pain unpleasantness, and current pain ratings among persons with chronic low-back pain. A second purpose was to enhance theoretical understanding of the mechanisms by which problem-solving appraisal influences adjustment. Correlational and regression procedures were used to test the hypothesized relations procedures between elements of self-appraised problem-solving ability and each criterion variable. Seventy-eight persons enrolled in an inpatient multidisciplinary chronic pain management program. The psychosocial subscale of the Sickness Impact Profile, the Beck Depression Inventory, the Beck Hopelessness Scale, the McGill Pain Questionnaire, and Visual Analogue Scales of Pain Sensory Intensity and Affective Response were the main outcome measures. After first controlling demographic characteristics, elements of self-appraised problem-solving ability assessed by the Problem-Solving Inventory were significantly predictive of depression, hopelessness, psychosocial impairment, and average pain unpleasantness (accounting for 20, 26, 29, and 11% of the respective variance in these constructs). Results indicate complex relations among the elements of problem-solving appraisal, suggesting that the Approach–Avoidance link to psychological adjustment was mediated by Problem-Solving Confidence. Comprehensive problem-solving interventions may be beneficial to persons with chronic pain

The COPE Program: Treatment Efficacy and Medical Utilization Outcome of a Chronic Pain Management Program at a Major Military Hospital

This study presents a treatment efficacy and medical utilization evaluation of a cognitive-behavioral, outpatient, chronic pain management program in a military hospital setting. A total of 61 nonmalignant chronic pain patients with heterogeneous pain syndromes who participated in sequential group programs were included in the study. Comprehensive and multi-dimensional outcome criteria were used, including pain ratings, relaxation skills, quality of life, satisfaction ratings, and medical utilization. The findings demonstrated improvements on all general indices. Military status had no effect on any of the outcome measures. Most significant was an 87% reduction in outpatient clinic visits in the first 3 months after treatment. This reduction amounts to a projected net annual saving of $78,960 in the first year after behavioral medicine intervention. In light of the increasing cost of health care for chronic pain patients, psychological approaches as an adjunct to traditional medical care seem to present a sound solution for cost savings. This study also supports the notion that a strategic biopsychosocial pain program, which targets the multiple dimensions of persistent pain, provides effective treatment and increases patient satisfaction.

When There Is No Benchmark: Designing a Primary Care-Based Chronic Pain Management Program from the Scientific Basis Up

Managed care has been accused of ignoring the patient with pain. The challenge for a health maintenance organization (HMO) was not just how to deliver state-of-the-art care, but how to deliver it to the 40,000 members who experience chronic pain at a reasonable cost and with enduring outcomes. This article describes how one managed care organization set about improving the care of patients with chronic pain. The article includes the design process, the model implemented, and some suggestions for transfer of this technology to others who might want to explore developing a similar model.

Evaluation of the effectiveness of a chronic pain management programme

Thirty-two chronic pain patients classified as dysfunc~onal (N=15); interpersonally distressed (N=9); or adaptive copers (N=8) on the West Haven-Yale Multidimensional Pain Inventory were evaluated before and aftera 3.5 week outpatient multimodal chronic pain management programme. Five patients also participated in a post-treatment focus group in which they gave accounts of their experiences of the programme. The three groups, which were demographically similar, did not differ in their response to the programme. There was an overall significant reduction (p<01) in mean depression scores on the Beck Depression Inventory and a near significant reduction (p<08) in mean scores on the functional limitations subscale of the Functional Limitations Profile when pre- and post-treatment scores were compared. There was no significant reduction in McGill Pain Questionnaire scores. A thematic content analysis of the focus group transcript showed that patients experienced ~he programme as improving their mood. their cap...

Human patterning and chronic pain.

The purpose of this study was to explore the nature of chronic pain through Rogerian nursing science. A matched sample was drawn from persons within chronic pain management programs (N = 113) and community dwelling adults without chronic pain (N = 113). The Human Field Motion Tool and the Power as Knowing Participation in Change Tool were used as measures of pattern manifestation (alphas = .94). Multivariate analysis of variance revealed significant differences between groups on patterning measures (p < .001). Although sociodemographic and pain variables were included in the analysis, they were not found to be related to patterning differences. The results of this study provide support for conceptualizing chronic pain as a pattern manifestation. Determining implications of this finding are among recommendations for knowledge development in explicating a nursing science perspective on pain.

Treatment helpfulness questionnaire: a measure of patient satisfaction with treatment modalities provided in chronic pain management programs

The Treatment Helpfulness Questionnaire (THQ) is presented as a reliable and valid measure for assessing patient perceptions of the helpfulness of treatment modalities offered at multidisciplinary pain centers. It is easy to administer and score and shows good interscorer and test-retest reliability without order effects and with good internal consistency. Patients give diverse responses to items that fall into four factors, three of which represent identifiable components of multidisciplinary treatment for chronic pain. Findings that similar THQ items are positively correlated and that many items show positive correlations with treatment outcome support the validity of the instrument. The latter finding also suggests the potential of patient satisfaction measurement for improving treatment outcomes at pain centers.

MANAGING CHRONIC NEUROPATHIC PAIN WITH IMPLANTED ANESTHETIC RESERVOIRS

An implantable pump set to deliver Marcaine at a specified rate can be a helpful addition to a chronic pain management program when other modalities have not been successful.

Another opinion on non-malignant pain management?

My appreciation of what is happening in the real world of pain management was enriched by my assumption of a consultant role for a review organization. As a tyro, I was amazed by the machinations of the various attending physicians their reluctance to approach 'benign pain' with a conservative and systematic regimen. As my experience with this organization deepened, my awe changed into disappointment. The usual slippery slope from non-steroidal meds to oral synthetic narcotics to injectables and ending with morphine pumps. Hardly ever did I see an effort for a comprehensive chronic pain management program. Occasionally, a psychologist would be consulted for an opinion in isolation! Another option often encountered was the continuation of acupuncture forever. While I'm. on the subject, passive physical modalities, e.g. acupuncture, diathermy, trigger point injections, myofascial releases, and massage are overused and abused. What's wrong with a short trial of treatment to see what works and then spend more time in instruction of the patient in a home program? Apparently, our colleagues have lost the notion that chronic pain needs attention by the patient every day.

The development of a battery of measures for assessing physical functioning of chronic pain patients

The physical performance of chronic pain patients is of major concern both for their assessment and for treatment evaluation. However, there are few widely used physical tests, a shortage of reliability and validity data on published tests, and an over-reliance on self-report or on clinical measures of dubious generalisability. A set of tests was designed to cover speed and endurance in walking, stair climbing, standing up from a chair, sit-ups, arm endurance, grip strength, and peak flow. Standard instructions and testing conditions were used by a trained tester on a population of chronic pain patients before and after a cognitive-behavioural chronic pain management programme. Reliability, validity, and acceptability of each test was examined, and recommendations made for their relative utility.

Interpretive Limitations of the MMPI-2 Anger and Cynicism Content Scales

Relationships between the Minnesota Multiphasic Personality Inventory-2 (MMPI-2; Butcher, Dahlstrom, Graham, Tetlegen, & Kaemmer, 1989) anger (ANG) and cynicism (CYN) content scales and concurrent measures of anger and subjective distress were examined among 97 men admitted to an inpatient chronic pain management program. Subjects completed the MMPI-2, StateTrait Anger Expression Inventory (Spielberger, 1988), State-Trait Anxiety Inventory (Spielberger, Gorsuch, Lushene, Vagg, & Jacobs, 1983), and Beck Depression Inventory (BDI; Beck, Ward, Mendelson, Mock, & Erbaugh, 1961) on the day of admission. Regression analyses indicated that Trait Anger was the best single predictor of ANG. CYN elevation was best predicted by BDI scores. Factor analyses revealed associations between ANG and anger externalization and between CYN and anger internalization. The results suggest that ANG is a reliable index of predispositions to the external expression of anger, whereas CYN is more difficult to characterize, perhaps be...

Chronic pain management support group: a program designed to facilitate coping.

Chronic low back pain is experienced by many. Pain management programs have been developed to help patients cope with their condition and learn ways to modify their lifestyle to reduce discomfort. This article describes the development, implementation, and evaluation of a chronic pain management program at one facility.

Use of a conceptually derived system for patient classification with the MMPI: Comparison of a multidisciplinary chronic pain management program (CPMP) to a substance abuse (AODA) population

Use of a conceptually derived system for patient classification with the MMPI: Comparison of a multidisciplinary chronic pain management program (CPMP) to a substance abuse (AODA) population

Chronic pain management.

In the past ten years developments in social psychology, neurochemistry, learning theory, and psychophysiology have expanded the concept of chronic pain into a biopsychosocial model, in which pain is viewed as a form of abnormal illness behavior influenced by a wide range of biological, social, and psychological factors. Using the literature on chronic pain, the authors discuss the evolution of the chronic pain concept into the multidisciplinary multimodal approach used by pain clinics today, and the factors identified in the literature that influence a patient's perception of pain. Finally, based on their experiences in setting up a pain clinic and on the literature on leading pain management programs, they discuss in detail the evaluation, treatment, and management strategies of a comprehensive chronic pain management program.

Prescription medication dependence and neuropsychologic function

The abuse of prescription drugs is an insidious complication among patients with chronic pain. This study examines cognitive intellectual functions in patients with chronic pain who are using prescribed analgesics, sedatives and hypnotics. A comprehensive battery of psychologic tests measuring intelligence, learning, memory, sensory-perceptual integrity, motor skills and general adaptive abilities was administered to 47 subjects. The subjects were patients admitted to a chronic pain management program, and they were divided into drug-dependent, drug-abusing and non-drug-abusing groups according to strictly defined criteria. Findings indicated that the prescribed use of these medications for pain over a prolonged time is detrimental to the cognitive function of such patients and complicates their clinical management.

Concealed litigation in a chronic pain management program

Concealed litigation in a chronic pain management program

Standards and accreditation for chronic pain management programs

Standards and accreditation for chronic pain management programs