Interdisciplinary Chronic Pain Management Program Research Articles

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.

Patient Satisfaction With Chronic Pain Management: Patient Perspectives of Improvement.

Integrating satisfaction measures with pain-related variables can highlight global change and improvement from the patients’ perspective. This study examined patient satisfaction in an interdisciplinary chronic pain management program. Nine hundred and twenty-seven (n = 927) participants completed pre- and post-treatment measures of pain, depression, catastrophizing, anxiety, stages of change, and pain acceptance. Multiple regression was used to examine these variables at admission and discharge as predictors of patient satisfaction. Pain-related variables explained 50.6% of the variance (R2 = .506, F 22,639 = 29.79, P < .001) for general satisfaction, and 38.9% of the variance (R2 = 0.389, F 22,639 = 18.49, P < .001) for goal accomplishment. Significant predictors of general satisfaction included depression (β = −0.188, P < .001) and the maintenance stage of change (β = 0.272, P < .001). The latter was also a significant predictor of goal accomplishment (β = 0.300, P < .001). Discharge pain-related measures are more influential than admission measures for predicting patient satisfaction. Patient satisfaction is significantly related to establishing a self-management approach to pain.

A Prospective Examination of Acceptance at a CBT-based Interdisciplinary Chronic Pain Management Program

A Prospective Examination of Acceptance at a CBT-based Interdisciplinary Chronic Pain Management Program

Behavioral inhibition, maladaptive pain cognitions, and function in patients with chronic pain

Background and aimsTrait behavioral inhibition represents a tendency to react with negative emotions – primarily worry – to cues which signal potential threats. This tendency has been hypothesized by a two-factor model of chronic pain to have direct effects on psychological and physical function in individuals with chronic pain, as well as to influence the associations between pain-related maladaptive cognitions and function. Our aim was to test these hypothesized associations in a sample of individuals who were being screened for possible interdisciplinary chronic pain treatment. MethodsEighty-eight patients referred to an interdisciplinary chronic pain management program were administered measures of average pain intensity, trait behavioral inhibition, kinesiophobia, pain catastrophizing, depressive symptoms, and pain interference. We then performed two linear regression analyses to evaluate the direct effects of trait behavioral inhibition on depressive symptoms and pain interference and the extent to which behavioral inhibition moderated the associations between kinesiophobia and pain catastrophizing, and the criterion variables. ResultsIn partial support of the study hypotheses, the results showed significant (and independent) direct effects of trait behavioral inhibition on depressive symptoms, and behavioral inhibition moderated the association between kinesiophobia and depression, such that there were stronger associations between kinesiophobia and depressive symptoms in those with higher dispositional sensitivity to fear-inducing stimuli. However, neither direct nor moderating effects of behavioral inhibition emerged in the prediction of pain interference. ConclusionsIf replicated in additional studies, the findings would indicate that chronic pain treatments which target both reductions in maladaptive cognitions (to decrease the direct negative effects of these on depressive symptoms) and the individual's tendency to respond to pain with worry (as a way to buffer the potential effects of maladaptive cognitions on depressive symptoms) might be more effective than treatments that targeted only one of these factors. ImplicationsAdditional research is needed to further evaluate the direct and moderating effects of pain-related behavioral inhibition on function, as well as the extent to which treatments which target behavioral inhibition responses provide benefits to individuals with chronic pain.

Learning to Manage Chronic Pain: The Patients' Perspective.

IntroductionThe objective of the present study was to gain insight into patients’ experiences in a 4-week interdisciplinary chronic pain management program by determining major themes from patients’ written comments on exit questionnaires.MethodsUpon completion of the program at the Chronic Pain Management Unit (CPMU), patients fill out program satisfaction (Pain Program Satisfaction Questionnaire) and evaluation of goal accomplishment (Self-Evaluation Scale) forms, sections of which are open-ended. Questionnaire data from 50 patients, admitted into the CPMU between May 2013 and December 2014, were randomly selected for this study. Written responses to open-ended sections were obtained. Comments were stratified by gender and coded using an inductive approach. Codes were grouped into categories which were further combined into several major themes.ResultsSix main themes extracted from comments were (1) impact of a strong interdisciplinary team, (2) learning to adapt in order to manage, (3) the Program as a stepping stone, (4) positive effects of a group effort, (5) improved mental health, and (6) benefits of the program.ConclusionThe results of this analysis reinforce the effectiveness of the interdisciplinary CPMU program at improving patients’ quality of life. Findings may assist in the promotion of the program to stakeholders such as referral sources. The outcomes may also assist in the development of future programs that have similar goals. Concerns that arise within patients’ comments may assist clinicians in this program to make adjustments such that all unique needs are met.Electronic supplementary materialThe online version of this article (doi:10.1007/s40122-016-0047-0) contains supplementary material, which is available to authorized users.

The American chronic pain crisis and the media: about time to get it right?

The American chronic pain crisis and the media: about time to get it right?

The Continuing and Growing Epidemic of Chronic Low Back Pain.

Because of the great prevalence of chronic pain, it is not surprising that there have been a number of influential reports by the Institute of Medicine, National Institutes of Health, and the World Health Organization that have documented the medical, social and economic problems caused by it, and the need for better pain-management programs. The present article briefly reviews these reports, and then focuses on three important areas that need to be considered when addressing the continuing and growing epidemic of one of the most prevalent types of chronic pain [chronic low back pain (CLBP)]: the biopsychosocial model of chronic pain; the paradigm shift in medicine from a disease model to an illness model of CLBP; and a review of the treatment- and cost-effectiveness of interdisciplinary chronic pain management programs. This overview will serve as an important prelude to other topics related to low back pain included in this Special Issue of Healthcare. Topics covered will range from assessment and treatment approaches, to important psychosocial mediators/moderators such as coping and pain beliefs.

Interdisciplinary chronic pain management: Past, present, and future.

Chronic pain is a significant and costly problem in the United States as well as throughout the industrialized world. Unfortunately, there have been concerns about the effectiveness of traditional medical interventions, suggesting the need for alternative chronic pain treatment strategies. However, the introduction of the biopsychosocial model of pain during the past decade stimulated the development of more therapeutically effective and cost-effective interdisciplinary chronic pain management programs. In the present article we briefly review the history of pain management, discuss the major components of a "true" interdisciplinary pain management program, focus on the evidence-based outcomes that have documented the effectiveness of such interdisciplinary pain management programs, and note the barriers that have blocked the wider use of such programs. Finally, we discuss future directions in interdisciplinary pain management.

Initial validation of a modified version of the Roland-Morris Disability Questionnaire (RMDQ) in a general chronic pain population

The original Roland Morris Disability Questionnaire (RMDQ) consists of 24 statements describing activity limitations stemming from back pain specifically, such as self-care and physical limitations. The RMDQ has shown good reliability and has also been utilized in languages other than English. An issue in many chronic pain clinics is that all types of pain from various anatomical structures are being treated, such as knee pain, wrist pain, etc., which raises the question of the ecological validity of the RMDQ when used with individuals suffering from chronic pain other than back pain. The current study examines the validity of a modified form of the RMDQ compared to the original version in individuals attending a multidisciplinary pain management clinic for chronic pain. Development of an instrument that can validly assess activity limitations due to chronic pain of various origins, not just back pain, is necessary in order to accurately assess the impact that an individual’s pain has on their functioning. Subjects were referrals for chronic pain management treatment with predominately low-back pain (62%) and a typical mix of other pain sites. Fifty sequential evaluations for admission into the interdisciplinary chronic pain management program were alternatively given the ORIGINAL or the MODIFIED RMDQ. Fifty sequential discharges from the 20-day interdisciplinary treatment were also alternatively given either version. A 2X2 ANOVA revealed a statistically significant PRE/POST reduction on both the ORIGINAL/MODIFIED versions (less self-rated disability). There were no significant mean differences between the two versions at either sample time nor was the interaction effect significant. The current investigation provides initial validation of a modified version of the RMDQ for a typical mix of individual referred to and participating in interdisciplinary pain management treatment. It is believed that such a modification allows more universal access to this type of self-reported disability questionnaire. The original Roland Morris Disability Questionnaire (RMDQ) consists of 24 statements describing activity limitations stemming from back pain specifically, such as self-care and physical limitations. The RMDQ has shown good reliability and has also been utilized in languages other than English. An issue in many chronic pain clinics is that all types of pain from various anatomical structures are being treated, such as knee pain, wrist pain, etc., which raises the question of the ecological validity of the RMDQ when used with individuals suffering from chronic pain other than back pain. The current study examines the validity of a modified form of the RMDQ compared to the original version in individuals attending a multidisciplinary pain management clinic for chronic pain. Development of an instrument that can validly assess activity limitations due to chronic pain of various origins, not just back pain, is necessary in order to accurately assess the impact that an individual’s pain has on their functioning. Subjects were referrals for chronic pain management treatment with predominately low-back pain (62%) and a typical mix of other pain sites. Fifty sequential evaluations for admission into the interdisciplinary chronic pain management program were alternatively given the ORIGINAL or the MODIFIED RMDQ. Fifty sequential discharges from the 20-day interdisciplinary treatment were also alternatively given either version. A 2X2 ANOVA revealed a statistically significant PRE/POST reduction on both the ORIGINAL/MODIFIED versions (less self-rated disability). There were no significant mean differences between the two versions at either sample time nor was the interaction effect significant. The current investigation provides initial validation of a modified version of the RMDQ for a typical mix of individual referred to and participating in interdisciplinary pain management treatment. It is believed that such a modification allows more universal access to this type of self-reported disability questionnaire.