Cognitive Behavioural Pain Management Programme Research Articles

Impaired Health-Related Quality of Life in Brazilian Children with Chronic Abdominal Pain: A Cross-Sectional Study.

We compared the health-related quality of life (HRQOL) of children and adolescents with functional abdominal pain disorders (FAPDs) and organic abdominal pain disorders (ORGDs). This was a single-center, cross-sectional, observational study. The PedsQL 4.0 generic cores scales parent proxy-report was administered to parents/caregivers of 130 and 56 pediatric patients with FAPDs and ORGDs respectively on their first visit. The self-reported pain intensity in the patients was assessed using a visual analog scale (VAS) and facial affective scale (FAS). Irritable bowel syndrome was the most prevalent FAPDs, and the most prevalent ORGDs were reflux esophagitis (41.1%) and gastritis associated with Helicobacter pylori (21.4%). There was no difference in HRQOL among patients diagnosed with ORGDs and FAPDs (p>0.05). Patients with ORGDs and FAPDs had lower HRQOL Scale scores than healthy Brazilian and American children's references, with a high proportion of children at risk for impaired HRQOL (p<0.0001). There was no difference in the VAS and the FAS scores between the ORGDs and the FAPDs. FAPDs had a higher prevalence of girls' and couples' disagreement (p<0.02), although poor school performance (p<0.0007) and bullying (p<0.01) were higher in patients with ORGD. This study revealed that there was a difference in impaired HRQOL between patients with ORGDs and FAPDs. Thus, considering the high prevalence of chronic abdominal pain in children, a well-founded treatment plan is necessary for a multidisciplinary cognitive-behavioral Pain management program.

Effects of a pain management programme on occupational performance are influenced by gains in self-efficacy

Introduction The perceived capacity to perform particular activities or skills (i.e. self-efficacy) is paramount in occupational therapy and is thought to be reinforced by actual functional capacity. This study examined whether changes in self-efficacy or confidence to lift weighted items influences changes in occupational performance and disability levels in patients attending a cognitive behavioural therapy pain management programme. Method Clients attending an 8-week cognitive behavioural therapy pain management programme ( N = 125) completed questionnaires before treatment, at discharge, and at 3-month and 6-month reviews, including measures of pain self-efficacy, disability and self-perceived performance and satisfaction using the Canadian occupational performance measure. Analyses examined disability and occupational performance over time, adjusting for baseline characteristics (age, sex, education), and sought to determine whether self-efficacy or lifting confidence influenced the outcomes. Results The level of disability, lifting confidence, self-efficacy and occupational performance all improved over time; however, only occupational performance and lifting confidence maintained improvements up to the 6-month review. Self-efficacy had a greater impact on occupational performance than lifting confidence.

Long-term results of an intensive cognitive behavioral pain management program for patients with chronic low back pain: a concise report of an extended cohort with a minimum of 5-year follow-up

PurposeTreatment options for chronic low back pain (CLBP) include cognitive behavioral interventions. Most of these interventions only have small and short-lived effects. Using strict inclusion criteria for participation in an intensive combined physical and psychological program, encouraging effects were reported at 1-year follow-up. This study evaluates the long-term follow-up results of the same program. The hypothesis is that previously reported results are maintained.MethodsStructured interviews were conducted in a prospective extended cohort with a minimum of 5-year follow-up in a similar fashion as in the 1-year follow-up report. The median follow-up in this cohort was 6.5 years. The extended cohort consisted of 277 patients (85% response).ResultsOutcomes include daily functioning, quality of life, current pain intensity, pain disturbance in daily activities and indicators of the use of pain medication and healthcare services. The previously reported positive 1-year follow-up results were maintained at a minimum of 5-year follow-up. Disability as measured with the Oswestry disability index (ODIv2.1a) decreased from 40 to 27 in the first year. This positive result was maintained at the 6.5-year follow-up with an ODI of 28. Pain intensity (NRS 0–100) improved from 60 to 39 in the first year, and at 6.5 years, this had further improved to 33. Improvement in quality of life (SF 36) at 1-year follow-up was maintained at 6.5-year follow-up, and healthcare consumption had decreased substantially as measured with doctor visits and analgesics used for CLBP.ConclusionSelected and motivated patients with longstanding CLBP improve fast after an intensive combined physical and psychological program in daily functioning, pain and quality of life. Positive 1-year results are maintained, and healthcare utilization was still reduced at a minimum of 5-year follow-up.Graphical abstractThese slides can be retrieved under Electronic Supplementary Material.

Estimating the Frequency, Severity, and Clustering of SPADE Symptoms in Chronic Painful Chemotherapy-Induced Peripheral Neuropathy

Background: Patients undergoing treatment for cancer commonly experience symptoms such as sleep disturbance, pain, anxiety, depression, and low energy/fatigue (SPADE), subsequently altering physical function and complicating effective symptom management. However, little is known about the frequency, severity, and clustering of SPADE symptoms in individuals with chronic painful chemotherapy-induced peripheral neuropathy (CIPN). Aims/Design: The purpose of this cross-sectional, secondary analysis was to describe the frequency, severity, and clustering of SPADE symptoms and their association with physical function in individuals with chronic painful CIPN. Participants/Subjects: Sixty individuals with chronic painful CIPN were recruited from five academic and community oncology outpatient centers to participate in a randomized controlled pilot trial designed to test the efficacy of a cognitive behavioral therapy-based pain management program. Methods: Participants completed the 0-10 Average CIPN Pain Numerical Rating Scale and Patient-Reported Outcome Measurement Information System measures for sleep-related impairment, anxiety, depression, fatigue, and pain interference via tablet before being randomly assigned to a study arm. The frequency, severity, and clustering of SPADE symptoms were calculated via descriptive statistics and Partitioning Around Medoids cluster analysis. Spearman rank correlation was performed to determine the association between number of SPADE symptoms and pain interference severity. Results and Conclusions: Participants (n = 59) experienced numerous SPADE symptoms. 66.1% of participants experienced at least two SPADE symptoms concurrently. The cluster analysis revealed high (n = 36) and low (n = 23) severity subgroups. There was a moderate correlation (r = 0.48) between the number of SPADE symptoms and pain interference severity. Determining the clustering of SPADE symptoms in individuals with chronic painful CIPN may lead to targeted multifaceted interventions to improve physical function.

Effectiveness, acceptability and feasibility of an Internet-delivered cognitive behavioral pain management program in a routine online therapy clinic in Canada

ABSTRACT Background Access to face-to-face cognitive behavioral pain management programs is very limited. Internet-delivered cognitive behavioral pain management has potential to improve client access to care but is not readily available in Canada. Aims The present study explored the effectiveness, acceptability, and feasibility of a previously validated Internet-delivered cognitive behavioral pain management course, the Pain Course, when offered in a publicly funded provincial Online Therapy Clinic. The five-lesson course was delivered over 8 weeks and was accompanied by brief weekly contact from a coach via weekly telephone calls and secure online messages. Methods A single-group open trial design (ISRCTN15509834) was employed (n = 55). Effectiveness was assessed by examining symptom measures at pretreatment, posttreatment, and 3-month follow-up. Completion rates and satisfaction ratings were used to examine acceptability. Feasibility was assessed by examining time required for service delivery. Results Results were highly comparable to past studies of the Pain Course showing improvements on primary measures of disability (Cohen’s d = 0.45; 18% reduction), depression (Cohen’s d = 0.85; 36% reduction), and anxiety (Cohen’s d = 0.52; 32% reduction) at posttreatment that were maintained at follow-up. Completion rates (76%) and course satisfaction ratings (85% would recommend course) were high. Coach time per week was estimated as M = 12.67 (SD = 6.53) min. Conclusions The findings add to existing literature on the Pain Course demonstrating for the first time the effectiveness, acceptability, and feasibility of Internet-delivered cognitive behavioral pain management programs for adults with chronic pain in a routine online therapy clinic.

A Cognitive Behavioural Therapy Pain Management Programme for Neuropathic Pain Post Spinal Cord Injury: A Feasibility Study Including the Clinician and Patient Perspectives

A Cognitive Behavioural Therapy Pain Management Programme for Neuropathic Pain Post Spinal Cord Injury: A Feasibility Study Including the Clinician and Patient Perspectives

Abstract PR327

Background & Objectives: Worldwide there is extensive morbidity due to musculoskeletal pain. This is problematic in developing countries due to the high cost and access to therapy. Agnikarma is an ancient surgical treatment for pain (1). It involves thermal cauterization (first or second degree burn) delivered precisely to the trigger point in the area of allodynia. Advances in herbal cream for burns has facilitated a revival and re evaluation of this technique. Our objective was to document that the technique can improve pain management for patients. In addition we set out to establish a clinical evidence base that was appropriate to time and place. This environment is not suitable for a randomised trial but holds the potential to make a significant statement on efficacy nonetheless. We set up the global Agnikarma centre - www.globalagnikarma.com to offer the treatment. Materials & Methods: The international consultants (authors) experts in pain medicine and holistic medicine agreed a protocol whereby the same clinical information was collected on every patient at each visit setting up an extensive clinical database. Furthermore an extensive video library of pre and post treatment records was generated. Having learned the technique the presenting author offered the treatment to a specific group of patients in Ireland. These patients all had a diagnosis of chronic pain and had failed all conventional pain management.They all had graduated from a cognitive behavioural pain management programme. 100 patients were invited to visit the web site and self select for treatment. Results: We treated 14173 patients with 39658 procedures as of 21-2-2016 over a two year period. The case mix was 50% knee, 25% lumbar spine, 15% shoulder & neck and 10 % miscellaneous. The average number of treatment sessions is three (range 1-6) to achieve benefit. In Ireland the one year audit data for resistant chronic pain - 51 patients self selected, 25 were deemed suitable and completed 4 sessions. 76% had greater than 50 % pain relief, 80% had improved function, 30 % had improved sleep, 60 % stated that the benefit was still present at the end of the year, 80 % would have the procedure again. Conclusion: We have introduced a novel interventional pain therapy which offers hope to patients suffering from pain as it is simple efficacious and sustained. We have set up a transparent clinical data base complemented by a clinical video library which can be audited by interested parties. We have piloted a sample audit in resistant chronic pain patients where no efficacy would be anticipated in a totally different environment and documented benefit. There is now sufficient proof of concept for a more detailed investigation.

Long-term follow-up Results of a Combined Physical and Psychological Program for Patients with Chronic Low Back Pain

IntroductionFor patients with persistent and disabling chronic low back pain (CLBP) who failed to improve after less intensive interventions, a combined physical and psychological (CPP) program including exercises and a cognitive behavioral approach, is recommended.1–3 These patients with CLBP participating in a two-week CPP-program improve in functional status and quality of life during the program and these positive results are maintained at one4 and at two-year follow-up assessment.5 Material and MethodsA consecutive cohort study with a mean follow up of 6.5 years (range: 5.5–7.5) was performed. At follow up a response rate of 85% (n = 277) was achieved. Primary outcome was functional status (Oswestry Disability Index [ODI;0–100]). Secondary outcomes were pain intensity, quality of life, and patient reported satisfaction. A Repeated Measures analysis of variance was used to identify changes over time. The two-week residential program is in line with recommendations in international guidelines1–3 and provided in collaboration with orthopedic spine surgeons at Sint Maartenskliniek Nijmegen, The Netherlands. ResultsAt pre-treatment assessment the mean age was 46.1years (SD9.3) and the mean CLBP-duration 12.3 years (SD10.9). The mean ODI-score showed improvement at post-treatment and maintenance of results over time (ODI df[1,276],F = 0.146,p = 0.703). Secondary outcomes showed the same pattern. At long-term follow up more than half of the CLBP-patients (59.2%) showed a clinically relevant improvement of ≥10 points on the ODI and 45.3% of the patients reached a functional status equivalent to an acceptable, normal healthy population value (ODI ≤ 22). This is comparable to the one-year follow-up assessment. 80.1% of the participants are satisfied with the treatment results and 76.2% would recommend the program to family/friends. ConclusionThe positive short-term effectiveness at one-year follow up of a two-week CPP-program is demonstrated to maintain over time. Patients demonstrate continued improvement of functional status and quality of life after 6.5 years of follow up. Moreover, at long-term follow up a high percentage of patients were satisfied with the results of the program and they would recommend the program to family and/or friends.ReferencesNational Institute for Health and Care Excellence. Clinical Guideline 88. Low back pain: Early management of persistent non-specific low back pain. May 2009Chou R, Loeser JD, Owens DK, et al; American Pain Society Low Back Pain Guideline Panel. Interventional therapies, surgery, and interdisciplinary rehabilitation for low back pain: an evidence-based clinical practice guideline from the American Pain Society. Spine 2009;34(10):1066–1077Airaksinen O, Brox JI, Cedraschi C, et al; COST B13 Working Group on Guidelines for Chronic Low Back Pain. Chapter 4. European guidelines for the management of chronic nonspecific low back pain. Eur Spine J 2006;15(Suppl 2):S192–S300van Hooff ML, van der Merwe JD, O'Dowd J, et al. Daily functioning and self-management in patients with chronic low back pain after an intensive cognitive behavioral programme for pain management. Eur Spine J 2010;19(9):1517–1526van Hooff ML, Ter Avest W, Horsting PP, et al. A short, intensive cognitive behavioral pain management program reduces health-care use in patients with chronic low back pain: two-year follow-up results of a prospective cohort. Eur Spine J 2012;21(7):1257–1264

OI0357 Cognitive-behavioral pain management programs for persistent orofacial pain

Persistent orofacial pain can have significant physical and psychologic effects. Outcomes for cognitive-behavioral pain management programs (CB PMPs) for people with widespread (nonfacial) pain show improvements in physical functioning and pain-related distress. The aim of this clinical study was to evaluate the effectiveness of a CB PMP for people with persistent orofacial pain. It was hypothesized that a CB PMP tailored to meet the needs of this population would significantly reduce the detrimental physical and psychologic effects of persistent orofacial pain.

Efficacy of an out-patient pain management programme for people with joint hypermobility syndrome

Joint hypermobility syndrome (JHS) is common in patients presenting to rheumatologists and can cause a range of symptoms leading to physical and psychological distress. Chronic musculoskeletal pain in patients with JHS often responds poorly to analgesics, and a pain management approach may be helpful. Since patients with JHS often have beliefs and experiences different to those of other chronic pain patients, they could fare better in JHS-specific programmes. Here, we report on the outcomes of patients in a JHS cognitive behavioural pain management programme. Patients fulfilling the Brighton criteria for JHS, who had suffered pain for at least 3months, were assessed by a psychologist and physiotherapist for suitability for this programme. Those accepted took part in a programme of 8days spread over 6weeks, delivered by a multidisciplinary team and incorporating a cognitive behavioural approach. Outcomes were assessed at baseline, 1- and 5-month post-programme using validated outcome measures. Outcome measures at baseline and 1-month were available for 87 patients (96% female, mean age 35years). There were significant improvements in self-efficacy, pain catastrophising, depression, anxiety, frustration, impact of pain and average pain intensity (all P < 0.001). Although by 5months all these outcomes had regressed towards pre-programme levels there remained significant improvements compared to baseline in all except average pain intensity. This open study shows that patients with JHS experienced significant benefits after attending a JHS-specific pain management programme, which were still evident 5months later. Longer-term controlled studies are required.

P 113. Effectiveness of anodal transcranial direct current stimulation in patients with chronic low back pain: Design, method and protocol for a randomised controlled trial

Background Electrical stimulation of central nervous system areas with surgically implanted stimulators has been shown to result in pain relief. To avoid the risks and side effects of surgery, transcranial direct current stimulation is an option to electrically stimulate the motor cortex through the skull. Previous research has shown that transcranial direct current stimulation relieves pain in patients with fibromyalgia, chronic neuropathic pain and chronic pelvic pain. Evidence indicates that the method is pain free, safe and inexpensive. Methods/Design A randomised controlled trial has been designed to evaluate the effect of transcranial direct current stimulation over the motor cortex for pain reduction in patients with chronic low back pain. It will also investigate whether transcranial direct current stimulation as a prior treatment enhances the symptom reduction achieved by a cognitive-behavioural group intervention. Participants will be randomised to receive a series of 5 days of transcranial direct current stimulation (2 mA, 20 min) or 20 min of sham stimulation; followed by a cognitive-behavioural group programme. The primary outcome parameters will measure pain (Visual Analog Scale) and disability (Oswestry Disability Index). Secondary outcome parameters will include the Fear Avoidance Beliefs Questionnaire, the Funktionsfragebogen Hannover (perceived function), Hospital Anxiety Depression Scale, bothersomeness and Health Related Quality of Life (SF 36), as well as Patient-Perceived Satisfactory Improvement. Assessments will take place immediately prior to the first application of transcranial direct current stimulation or sham, after 5 consecutive days of stimulation, immediately after the cognitive-behavioural group programme and at 4 weeks, 12 weeks and 24 weeks follow-up. Discussion This trial will help to determine, whether transcranial direct current stimulation is an effective treatment for patients with chronic low back pain and whether it can further enhance the effects of a cognitive behavioural pain management programme. Trial registration: Current Controlled Trials ISRCTN89874874.

Ulysses: the effectiveness of a multidisciplinary cognitive behavioural pain management programme—an 8-year review

To characterise a cohort of patients with chronic pain registered to the Ulysses cognitive behavioural pain management programme (CBT-PMP) and to evaluate the effectiveness of the CBT-PMP 6 months post-discharge. A review of patients referred to the Ulysses CBT-PMP from 2002 to 2010 was undertaken. The profile of patients was established. Domains measured included pain, physical and psychological function. Relationships between these factors were explored. Clinically significant changes in outcome measures were established at the 6-month follow-up. In total 553 patients registered to the CBT-PMP, pre-post data were available for 91 % of patients and 52 % at 6 months. The majority of patients were female and aged between 40 and 50 years. Most patients had significant psychological morbidity (76 % depression, 84.5 % anxiety), moderate reports of pain [numerical rating scale, mean (SD) 6.0 (2.2)], and low levels of functional activity. At 6 months follow-up, statistically significant positive findings for physical and psychological outcome measures are supplemented by results showing their clinical significance. With regard to psychological function, a clinically significant change (depending on outcome measure) was shown between 1 in 2 and 1 in 10 patients. Improvements in physical function were lower with rates of 1 in 4 to 1 in 14 reporting significant gains. The effectiveness of the Ulysses CBT-PMP is established with measures of clinically significant change for physical and psychological outcomes contributing to the evidence for this novel approach of analysis. Future research determining benchmarks for CBT-PMP outcomes will assist clinicians in monitoring and enhancing patient's progress in clinical practice.

Evaluation of a Cognitive–Behavioral Pain Management Program for Children with Chronic Abdominal Pain: A Randomized Controlled Study

Chronic abdominal pain (CAP) in childhood is widely prevalent and has adverse effects on mental health and quality of life. Earlier research emphasized the positive effects of psychological intervention on pain symptoms. This study describes the results of a cognitive-behavioral pain management program for children with CAP. The newly developed cognitive-behavioral group program, "Stop the pain with Happy-Pingu," includes six sessions for the children and one meeting for the parents. We hypothesized that the training would significantly reduce pain symptoms (frequency, duration, intensity, and pain-related impairment) and increase health-related quality of life compared to wait-list controls, with improvement seen both at the end of treatment and at a 3-month follow-up. In all, 29 children were randomized into two groups: 15 in the intervention group (IG) and 14 as the wait-list controls (WLC). An intent-to-treat analysis was performed using two-factorial multivariate analyses of variance with repeated measures. Children in the IG experienced both a reduction in pain (primary outcome) and an improvement in health-related quality of life (secondary outcome) as compared to the WLC. The effect sizes ranged from medium to high. Cognitive-behavioral methods seem to be appropriate for treating children with CAP.

Self-management of chronic pain in Malaysian patients: effectiveness trial with 1-year follow-up.

Self-management of chronic illnesses has been widely recognised as an important goal on quality of life, health service utilisation and cost grounds. This study describes the first published account on the application of this approach to people suffering from chronic pain conditions in a Southeast Asian country, Malaysia. A heterogeneous sample of chronic pain patients in Malaysia attended a 2-week cognitive–behavioural pain management programme (PMP) aimed at improving daily functional activities and general psychological well-being. Complete datasets from 70 patients out of 102 patients who attended 11 programmes conducted from 2002 to 2007, as well as the 1-month and 1-year follow-up sessions at the hospital clinic, are reported. The pre- to post-treatment results on self-report measures indicate that significant gains were achieved on the dimensions of pain, disability and psychological well-being. These gains were maintained at both 1-month and 1-year follow-ups. The results mirror those reported from similar interventions in Europe and North America and indicate the concept of self-management of a chronic illness is acceptable and meaningful to Asian patients. Importantly, the achieved outcomes were independent of gender and ethnic group status.

A short, intensive cognitive behavioral pain management program reduces health-care use in patients with chronic low back pain: two-year follow-up results of a prospective cohort.

PurposeCognitive behavioral interventions are recommended as non-invasive treatment options for patients with chronic low back pain (CLBP). However, most treatment effects are small and short-lived. Although a 2-week intensive pain management program for patients with CLBP seems to be effective, the long-term results are not known. The purpose of this study is to evaluate the stability of the 2-year follow-up results and whether this is reflected in the use of health-care services.MethodsA prospective cohort study was performed. Pre-treatment characteristics of patients and data of outcomes obtained at 1-year follow-up were used. At 2-year follow-up a structured interview was conducted following the principles of a post-marketing survey. Outcomes included daily functioning, quality of life, current intensity of pain, disturbance of pain during daily activities, and indicators of the use of pain medication and health-care services.ResultsOf the 90 eligible patients 85 (94%) participated in the post-marketing survey. The 1-year clinical relevant effects are maintained at 2-year follow-up. Effect sizes for functioning and quality of life were large. More than 65% reached preset minimal clinically important differences. At pre-treatment all patients consulted their general practitioner (GP) and medical specialist (MS). At 2-year follow-up 73% reported having consulted neither a GP nor an MS during the previous year. Most of the patients indicated not to use any pain medication (57%) and the percentage patients using opioids have decreased (14%). Moreover, 81% reported to be at work.ConclusionsThe gained results from selected and motivated patients with longstanding CLBP at 1-year follow-up are stable at 2-year follow-up. Above all, most of the participants are at work and results indicate that the use of both pain medication and health care have decreased substantially.

Effectiveness of anodal transcranial direct current stimulation in patients with chronic low back pain: Design, method and protocol for a randomised controlled trial

BackgroundElectrical stimulation of central nervous system areas with surgically implanted stimulators has been shown to result in pain relief. To avoid the risks and side effects of surgery, transcranial direct current stimulation is an option to electrically stimulate the motor cortex through the skull. Previous research has shown that transcranial direct current stimulation relieves pain in patients with fibromyalgia, chronic neuropathic pain and chronic pelvic pain. Evidence indicates that the method is pain free, safe and inexpensive.Methods/DesignA randomised controlled trial has been designed to evaluate the effect of transcranial direct current stimulation over the motor cortex for pain reduction in patients with chronic low back pain. It will also investigate whether transcranial direct current stimulation as a prior treatment enhances the symptom reduction achieved by a cognitive-behavioural group intervention. Participants will be randomised to receive a series of 5 days of transcranial direct current stimulation (2 mA, 20 mins) or 20 mins of sham stimulation; followed by a cognitive-behavioural group programme. The primary outcome parameters will measure pain (Visual Analog Scale) and disability (Oswestry Disability Index). Secondary outcome parameters will include the Fear Avoidance Beliefs Questionnaire, the Funktionsfragebogen Hannover (perceived function), Hospital Anxiety Depression Scale, bothersomeness and Health Related Quality of Life (SF 36), as well as Patient-Perceived Satisfactory Improvement. Assessments will take place immediately prior to the first application of transcranial direct current stimulation or sham, after 5 consecutive days of stimulation, immediately after the cognitive-behavioural group programme and at 4 weeks, 12 weeks and 24 weeks follow-up.DiscussionThis trial will help to determine, whether transcranial direct current stimulation is an effective treatment for patients with chronic low back pain and whether it can further enhance the effects of a cognitive behavioural pain management programme. Trial registration: Current Controlled Trials ISRCTN89874874.

The impact on sleep of a multidisciplinary cognitive behavioural pain management programme: a pilot study

BackgroundReduced sleep quality is a common complaint among patients with chronic pain, with 50-80% of patients reporting sleep disturbance. Improvements in pain and quality of life measures have been achieved using a multidisciplinary cognitive behavioural therapy pain management programme (CBT-PMP) that aims to recondition attitudes to pain, and improve patients' self-management of their condition. Despite its high prevalence in patients with chronic pain, there is very limited objective evidence for the effect of this intervention on sleep quality. The primary research objective is to investigate the short-term effect of a multidisciplinary CBT-PMP on subjective (measured by Pittsburg Sleep Quality Index) and objective sleep quality (measured by Actigraphy) in patients with chronic pain by comparison with a control group. The secondary objectives will investigate changes in function and mood, and then explore the relationship between objective and subjective sleep quality and physical and psychological outcome measures.Methods/DesignPatients who fulfil the inclusion criteria for attendance on the multidisciplinary CBT-PMP in the Adelaide and Meath Hospital, Tallaght, Dublin and are currently listed on the PMP waiting list will be invited to participate in this pilot study. Potential patients will be screened for sleep disturbance [determined by the Pittsburgh Sleep Quality Index (PSQI)]. Those patients with a sleep disturbance (PSQI >5) will be assigned to either the intervention group (immediate treatment), or control group (deferred treatment, i.e. the PMP they are listed for is more than six months away) based on where they appear on the waiting list. Baseline measures of sleep, function, and mood will be obtained using a combination of self-report questionnaires (the Hospital Anxiety and Depression Scale, the Short Form 36 health survey, the Pittsburgh Sleep Quality Index, the Tampa Scale for Kinesiophobia), and functional outcome measures. Sleep will be measured for seven days using actigraphy (Actiwatch 7). These measures will be repeated after the four week multidisciplinary cognitive behavioural therapy pain management programme, and at a two month follow-up. The waiting list control group will be assessed at baseline, and two months later. Analysis for the primary outcome will include between group differences of subjective and objective sleep parameters from baseline to follow-up using Independent T-tests or Mann-Whitney U tests. The secondary outcomes establishing relationships between the sleep variables and physical and psychological outcome measures will be established using multiple linear regression models.DiscussionThis pilot study will evaluate the impact of a multidisciplinary CBT-PMP on both subjective and objective measures of sleep in patients with chronic pain and provide guidance for a larger clinical trial.Trial RegistrationCurrent controlled trial ISRCTN: ISRCTN74913595

Comparison of a Pain Management Program With Usual Care in a Pain Management Center for People With Spinal Cord Injury-related Chronic Pain

To evaluate the effectiveness of a specifically modified group-based, multidisciplinary cognitive-behavioral pain management program (PMP) in comparison to usual care in a clinical sample of people with spinal cord injury (SCI)-related chronic pain. Changes over time on a range of measures, including usual pain intensity, pain catastrophizing and self-efficacy, mood, SCI acceptance and self-efficacy, and interference due to pain were examined in 2 groups with SCI-related chronic pain after a multidisciplinary pain assessment. One group (n=19) attended the PMP, and the other (n=17) received standard care on an individualized basis in a pain management center. The groups were significantly different at baseline, with the PMP group scoring more negatively on a number of the measures, including usual pain intensity. The PMP group showed an overall improvement in mood and life interference due to pain at the end of the PMP when compared with the usual care group. Within the PMP group, there was a significant improvement over time in anxiety and pain catastrophizing. No changes in SCI-related psychologic variables (acceptance and self-efficacy) were observed in either group. This study demonstrates that a PMP may offer benefits to clinical populations with SCI-related chronic pain in a pain management center. The reported improvements were of a magnitude to be clinically significant. However, some of the initial benefits reported were not maintained at the nine month follow-up. The interventions may need to be augmented to address the effects of SCI-related psychologic variables that may impact upon the individual's ability to benefit from a PMP.

Evaluation of a multidisciplinary outpatient pain management programme based at a community hospital

To evaluate a multidisciplinary cognitive behavioural therapy pain management programme (PMP) based at a small community hospital. Patients attending the PMP were assessed at three intervals (pre-training, and 18 and 44 weeks post-training) using a set of seven questionnaires. Information about their general practitioner (GP) and consultant visits was recorded at pre-training and final follow-up visits. Questionnaires were completed and additional personal information recorded before patients attended their appointments. Between 1997 and 2006, 163 patients completed at least six sessions out of the eight-week programme. Of these, 70 who had completed at least one questionnaire outcome measure at the three assessment intervals, and 83 who had provided information on their GP and consultant visits at pre-training and final follow-up, were included in the analyses. The results showed that patients reported being more confident in coping with their pain (pain self-efficacy questionnaire) at 18 weeks post-training and their improvement was sustained at the final follow-up. They were significantly less depressed (hospital and anxiety depression scale [HADS]) and reported a large improvement in their quality of life (modified patient generated index) at the final follow-up. They also reported a significant reduction in pain-related GP and consultant visits at their final follow-up. Although there were improvements in the Tampa scale of kinesiophobia, anxiety (HADS-Anx) and sickness impact profile scores, these were not statistically significant. The result of the evaluation indicated that this PMP, delivered in a community hospital setting, made some significant differences to patients with intractable chronic pain conditions.

(201) The Effect of an Integrated Cognitive-Behavioral Pain Management Program on Pain Intensity, Self-efficacy Beliefs and Depression in Chronic Pain Patients on Completion and One Year Later

Cognitive-behavioral treatment programs have demonstrated the ability to reduce pain, emotional distress and disability for individuals with chronic pain. Investigators suspect a change in self-efficacy beliefs may be the mechanism by which these positive outcomes occur. This investigation examined pre- and post-program data from participants of an integrated cognitive-behavioral program, to identify patterns of change in the areas of pain intensity (visual analogue scale), self-efficacy beliefs (Chronic Pain Self-Efficacy Scale), pain-related disability (Pain Disability Index) and depression (CES-D) in 170 chronic pain patients. At the end of the 10-session treatment program, the greatest area of change was an increase in self-efficacy levels by 38% from baseline. This increase was significantly (p < 0/00.1) associated with a 24% reduction in pain intensity, while disability and depression scores declined by 17% and 28% respectively. Patients responding to a follow-up survey one year after completion (n = 41) reported continued improvements. Pain, disability and depression scores declined to 27%, 25%, and 32% respectively. Self-efficacy scores remained the same (38% higher than baseline) as the immediate post-program scores remained the same (38% higher than baseline) as the immediate post-program measures. All were significant at the p < 0.001 level. Changes remained significant after controlling for pain intensity, and use of antidepressants &/or opioids. Self-efficacy levels at the conclusion of the program were significantly (p < 0.01) related to pain intensity (r = −.58), disability (r = −.65) and depression (r = −.65). In the one-year data set, even stronger associations were noted. Conclusion: Support continues to mount that desirable outcomes occur as a result of participation in an integrated cognitive-behavioral pain program. Reductions in pain, disability and depression occur in association with an enhancement in self-efficacy beliefs. The beneficial effects of the program continue after its conclusion, as pain, disability and depression scores continue to fall, and self-efficacy continues to rise one year after program completion.