Interdisciplinary Chronic Pain Rehabilitation Research Articles

Consultations Preliminary to Interdisciplinary Chronic Pain Rehabilitation

Before patients with chronic pain enter an interdisciplinary chronic pain rehabilitation programme, a team of various healthcare professionals performs a biopsychosocial analysis of their pain problem. To enhance patients’ engagement, the problem analysis is thoroughly discussed with them in order to gain a shared understanding of the nature of their pain problem. This study explores how patients and practitioners talk through their rehabilitation team’s hypotheses regarding the psychosocial factors involved in these patients’ health situation. Nine consultations were recorded at various Dutch interdisciplinary chronic pain rehabilitation units. The recordings were transcribed and analysed, combining an applied conversation analytic research approach with discursive psychology. Patients and practitioners are found to orient to ensuring consensus on the problem analysis as a relevant activity and tend to avoid or minimize the articulation of differences in perspectives. This study also shows that this orientation to consensus involves a delicate management of issues of accountability and blame. Findings can be used by practitioners to consider communication practices that are more likely to encourage patients to voice potential concerns regarding their rehabilitation team’s findings.

Impact of the Interdisciplinary Chronic Pain Rehabilitation Programme in patients with and without sleep disorders

Sleep disorders and chronic pain are linked to each other bidirectionally. Both are related to affective disorders, fatigue, depression, anxiety and drug abuse, and have a significant effect on quality of life. The Interdisciplinary Pain Programme (IDP) aims to relieve the patients' pain and improve their functionality by incorporating healthy postural, sleep and nutritional habits, relaxation techniques, physical exercise and cognitive-behavioural mechanisms. A retrospective, observational, cross-sectional study was conducted. A total of 323 patients with chronic pain who completed the IDP were examined. They were assessed at the beginning and at the end of the programme with pain, depression, quality of life and insomnia scales, and were then compared between groups with and without insomnia, that is, with an insomnia severity index (ISI) less than 15 versus greater than or equal to 15. Fifty-eight patients were studied by means of polysomnography. A significant improvement (p < 0.0001) in pain, depression and quality of life, as assessed by the visual analogue scale (VAS), the Beck inventory and the Short Form-36 (SF-36) questionnaire was observed in chronic pain patients with an ISI below 15 and in those with an ISI greater than or equal to 15. The results were superior in the group of patients with insomnia. The presence of a high apnoea and hypopnoea index and periodic lower limb movements in patients was not related to improvements on the Beck, SF-36, ISI and VAS scales. In conclusion, IDP benefits patients with chronic non-cancer-induced pain in several affected areas, in addition to pain, due to a comprehensive treatment. Polysomnography can help diagnose specific pathologies and individualise pharmacological treatment.

An interdisciplinary chronic pain rehabilitation program effectively treats impairment in sexual function, depression, alexithymia, and pain in women with chronic pelvic pain

Purpose Chronic pelvic pain (CPP) in women is often associated with marked emotional distress and disability, with particular impairments in sexual functioning. Research supports the efficacy of interdisciplinary chronic pain rehabilitation programs (ICPRPs) in treating chronic pain, however less is known about their utility in CPP. Methods This retrospective study examined pain-related sexual impairment, emotional symptoms, and pain severity in CPP patients before and after completing a 3–4 week ICPRP. Predictors of post-treatment sexual impairment were also investigated. Participants included 58 female CPP patients and 58 age-matched females with non-pelvic chronic pain (NPCP). Results All participants reported robust improvements across outcome measures. Women with CPP reported greater pre- and post-treatment impairment in sexual function than NPCP patients, despite significant treatment-related improvements. In contrast, CPP patients also reported higher levels of depression at baseline but showed greater treatment related-improvements. In participants with CPP, treatment-related improvements in depression, alexithymia, and pain severity significantly explained decreases in pain-related sexual impairment following treatment, whereas none of these variables explained sexual impairment outcomes in women with NPCP. Conclusion Results demonstrate that ICPRPs can effectively treat CPP, particularly through changes in depression and alexithymia. Future research should examine whether specific interventions can be added in ICPRPS to address CPP-related sexual impairment.

Treatment Outcomes and Mechanisms for an ACT-Based 10-Week Interdisciplinary Chronic Pain Rehabilitation Program.

Interdisciplinary pain rehabilitation programs are an evidence-based biopsychosocial treatment approach for chronic pain. The purpose of the current study is to assess outcomes for a 10-week interdisciplinary, acceptance and commitment therapy (ACT)-based, outpatient treatment model and to evaluate the relationship between psychological process variables (ie, pain catastrophizing, pain acceptance, pain self-efficacy) and treatment outcomes. 137 adults with chronic pain completed an interdisciplinary pain rehabilitation program. Measures of pain, pain interference, health-related quality of life, anxiety, depressed mood, insomnia, pain catastrophizing, pain acceptance, and pain self-efficacy were completed at admission and discharge. Data were also collected on demographic and clinical variables, including opioid use. Results indicated significant changes in all measures at program discharge compared to admission. Opioid doses were also reduced. Results of within-subjects meditational analyses indicated that pain catastrophizing accounted for a significant portion of the treatment effect for pain severity, pain interference, and depressed mood. Pain acceptance was a mediator for change in depressed mood, whereas pain self-efficacy was a mediator for pain interference outcomes. This study supports a 10-week, ACT-based treatment model for interdisciplinary chronic pain rehabilitation. In addition, pain catastrophizing, pain acceptance, and pain self-efficacy were each found to be mechanisms by which individuals achieve successful treatment outcomes. This research provides further support for interdisciplinary rehabilitation approaches for chronic pain.

Functional Neurological Disorder Responds Favorably to Interdisciplinary Rehabilitation Models

Functional neurological disorder (FND) is difficult to treat and costly. Interdisciplinary chronic painrehabilitation programs (iCPRPs) are multidimensional functional restoration interventions for pain; their impact on FND specifically has not been assessed. The purpose of this study was to assess iCPRP's impact on functioning in FND. Data were examined retrospectively from anInstitutional Review Board-approved registry capturing admission and discharge data from patients participatingin an outpatient iCPRP. Subjective measures included pain-related disability, depression, anxiety, and stress scores, whereas objective measures included physical functioning measures (timed up and go, stair climbing test, and 6-min walk test). Pre-iCPRP and post-iCPRP measures were compared using a paired t-test approach. Forty-nine FND patients completed care and showed pre-measures and postmeasures. Statistically significant reductions in subjective measures of pain-related disability (46.40-20.91; P<0.001, d=1.92), depression (20.38-4.81; P<0.001, d=1.53), anxiety (15.09-6.29; P<0.001, d=1.18), and stress (21.96-9.70; P<0.001, d=1.21) scores were observed. Statistically significant changes in objective measures of mean timed up and go scores (decreased from 15.96 to 8.87 s), stair climbing test scores (increased from 40.98 to 71.93 steps), and mean 6-minute walk test scores (increased from 0.21 to 0.30 miles) were also observed across the group. While preliminary and based on a small patient sample, these findings support the use of interdisciplinary care models for FND treatment. Clinical and investigational implications are explored.

Clinical and Demographic Predictors of Interdisciplinary Chronic Pain Rehabilitation Program Treatment Response

Patients treated in interdisciplinary chronic pain rehabilitation programs show long-term improvements in symptoms; however, outcomes may vary across heterogenous patient subpopulations. This longitudinal retrospective study characterizes the influence of opioids, mood, patient characteristics, and baseline symptoms on pain and functional impairment (FI) in 1,681 patients 6-months to 12-months post-treatment in an interdisciplinary chronic pain rehabilitation program incorporating opioid weaning. Linear mixed models showed immediate and durable treatment benefits with nonuniform worsening at follow up which slowed over time. Latent class growth analysis identified three post-treatment trajectories of pain and FI: mild symptoms and durable benefits, moderate symptoms and durable benefits, and intractable symptoms. A fourth pain trajectory showed immediate post-treatment improvement and worsening at follow up. Whether a patient was weaned from opioids was not predictive of treatment trajectory. Racial ethnic minority status, higher levels of post-treatment depression, and lower perceived treatment response were associated with less resolution (moderate symptoms) or intractable symptoms. Not having a college education was predictive of intractable or worsening pain and a moderate course of FI. Older age and male gender was associated with intractable FI. Treatment outcomes may be improved by the development of targeted interventions for patients at risk of poor recovery and/or deteriorating long-term course. PerspectiveThis study examined predictors of treatment response in 1,681 patients treated in an interdisciplinary chronic pain rehabilitation program incorporating opioid weaning. Opioid weaning did not predict outcome. Higher levels of symptoms, lower levels of education, and being a racial-ethnic minority were associated with a less salubrious long-term treatment response.

(164) - Evaluating objective and subjective treatment benefits in women with chronic pelvic pain treated in an interdisciplinary chronic pain rehabilitation

(164) - Evaluating objective and subjective treatment benefits in women with chronic pelvic pain treated in an interdisciplinary chronic pain rehabilitation

A Network Analysis of Depressive Symptoms in Individuals Seeking Treatment for Chronic Pain.

Major depression in the context of chronic pain has been conceptualized implicitly as a latent variable, in which symptoms are viewed as manifestations of an underlying disorder. A network approach provides an alternative model and posits that symptoms are causally connected, rather than merely correlated, and that disorders exist as systems, rather than as entities. The present study applied a network analysis to self-reported symptoms of major depression in patients with chronic pain. The goals of the study were to describe the network of depressive symptoms in individuals with chronic pain and to illustrate the potential of network analysis for generating new research questions and treatment strategies. Patients (N=216) admitted to an interdisciplinary chronic pain rehabilitation program provided symptom self-reports using the Patient Health Questionnaire-9. Well-established network analyses methods were used to illustrate the network of depressive symptoms and determine the centrality of each symptom (ie, the degree of connection with other symptoms in the network). The most central symptoms were difficulty concentrating, loss of interest or pleasure, depressed mood, and fatigue, although the relative position of each symptom varied slightly, depending on the centrality measure considered. Consistent with past research with patients undergoing treatment for major depression, the current findings are supportive of a model in which depressive symptoms are causally connected within a network rather than being manifestations of a common underlying disorder. The research and clinical implications of the findings, such as developing treatments targeting the most central symptoms, are discussed.

Medical cannabis use among patients with chronic pain in an interdisciplinary pain rehabilitation program: Characterization and treatment outcomes

IntroductionCannabis is increasingly being used in the treatment of chronic pain. However, there is a lack of available research in the population of patients with chronic pain who are using cannabis. The current study examines clinical and treatment characteristics for patients who are admitted to a 3-week outpatient interdisciplinary chronic pain rehabilitation program. MethodParticipants (N=48) included patients with a positive urine drug screen for 9-carboxy-tetrahydrocannabinol (THC(+); n=24) and a matched comparison sample of patients with a negative screen (THC(−); n=24). Participants were matched for age, gender, race, education, and current prescription opioid use. Measures of pain, functioning, and quality of life were completed at admission and discharge. Medical chart review was conducted to assess medication and substance use history. ResultsParticipants with a positive screen for THC were more likely to report a past history of illicit substance use, alcohol abuse, and current tobacco use. Cannabis use was not associated with a significantly lower morphine equivalence level for participants using prescription opioids (n=14). Both groups of participants reported significant improvement in pain severity, pain interference, depressive symptoms, and pain catastrophizing. There were no group- or treatment-related differences in these outcome variables. DiscussionResults provide preliminary evidence that patients with chronic pain using cannabis may benefit from an interdisciplinary chronic pain program. Patients with chronic pain using cannabis may be at higher risk for substance-related negative outcomes, although more research is needed to understand this relationship.

Sustained improvements in pain, mood, function and opioid use post interdisciplinary pain rehabilitation in patients weaned from high and low dose chronic opioid therapy.

Increased prescribing of opioids for chronic noncancer pain is associated with significant social costs, including overdose and addiction. In this context, there is interest in interdisciplinary chronic pain rehabilitation programs focusing on self-management and minimizing opioid use. This study examined outcomes of patients weaned from opioids in an ICPRP from 2007 to 2012. Participants included 413 patients on high dose chronic opioid therapy (COT; >100 mg), 528 on low dose COT, and 516 not on opioids (NO). Outcomes were assessed at discharge, 6, and 12 months posttreatment through self-report and chart review. One thousand one hundred ninety-four participants completed treatment (81.95%); 86.74% of those on opioids were weaned. High doses were less likely to complete (78.45%) than NO participants (85.27%; P < 0.05). Results showed immediate (P < 0.01) and sustained improvements (P < 0.05) in pain severity, depression, anxiety, and functional impairment with no group differences. Effect sizes ranged from medium to large (Cohen d values 0.57-1.96). Longitudinal medication use data were available for 319 no dose and 417 weaned participants; opioid resumption rates were 10.51% and 30.70% respectively. There were no differences in resumption between the high dose and low dose groups. Logistic regression analyses determined that opioid dose predicted neither treatment completion nor opioid resumption. Anxiety predicted completion, and functional impairment predicted opioid resumption within 1 year of discharge. Results suggest that patients on COT can be successfully weaned with long-term benefits in pain, mood, and function. Targeting anxiety and functional restoration may increase success rates.

Unique Contributions of Acceptance and Catastrophizing on Chronic Pain Adaptation.

Pain catastrophizing and acceptance represent distinct but interrelated constructs that influence adaptation to chronic pain. Clinical and laboratory research suggest that higher levels of catastrophizing and lower levels of acceptance predict worse functioning; however, findings have been mixed regarding which specific outcomes are associated with each construct. The current study evaluates these constructs in relation to pain, affect, and functioning in a treatment-seeking clinical sample. Participants included 249 adult patients who were admitted to an interdisciplinary chronic pain rehabilitation program and completed measures of pain and related psychological and physical functioning. Hierarchical multiple regression analyses indicated that pain catastrophizing and acceptance both significantly, but differentially, predicted depressive symptoms and pain-related negative affect. Only pain catastrophizing was a unique predictor of perceived pain severity, whereas acceptance uniquely predicted pain interference and performance in everyday living activities. There were no significant interactions between acceptance and catastrophizing, suggesting no moderation effects. Findings from the current study indicate a pattern of results similar to prior studies in which greater levels of catastrophic thinking is associated with higher perceived pain intensity whereas greater levels of acceptance relate to better functioning in activities despite chronic pain. However, in the current study, both acceptance and catastrophizing were associated with negative affect. These relationships were significant beyond the effects of clinical and demographic variables. These results support the role of pain acceptance as an important contribution to chronic pain-related outcomes alongside the well-established role of pain catastrophizing. Results are limited by reliance on self-report data, cross-sectional design, and low racial/ethnic diversity.

Clinically Important Change in Insomnia Severity After Chronic Pain Rehabilitation.

Insomnia is a common problem for people with chronic pain. It is unclear, however, whether interdisciplinary treatment centered on pain management, rather than sleep, confers a benefit in reducing insomnia symptoms. In this study, we examined clinically important change in insomnia severity following participation in an interdisciplinary chronic pain rehabilitation program. A total of 140 patients (43 men and 97 women) completed a 4-week outpatient day program for interdisciplinary rehabilitation that incorporated psychoeducation about pain, physical fitness, and group psychotherapy. The Insomnia Severity Index (ISI) was included as an outcome, along with measures of pain, mood, and function. On the ISI before treatment, 20 patients (14.3%) reported no insomnia, 36 (25.7%) had a mild or subthreshold problem, and 84 (60%) had moderate (31.4%) or severe (28.6%) clinical insomnia. After treatment, ISI scores showed a statistically significant improvement overall (P<0.001). Six indices of individual change were examined among those with moderate-severe insomnia at baseline. Depending on the index used, rates of clinically important improvement ranged from 2.4% to 47.6%; however, only 2 patients with insomnia met criteria for full remission. Among patients with no or subthreshold symptoms at baseline, from 0% to 14.3% were worse after treatment, depending on the criterion. Insomnia improves overall following interdisciplinary rehabilitation for chronic pain, but most patients with clinical insomnia continue to have a significant sleep problem after treatment, and some patients may get worse. Interventions to alleviate persistent insomnia comorbid with chronic pain are likely to require a more intensive focus on sleep itself.

(534) Chronic pelvic pain is effectively treated in an interdisciplinary chronic pain rehabilitation program

(534) Chronic pelvic pain is effectively treated in an interdisciplinary chronic pain rehabilitation program

Sex differences between Veterans participating in interdisciplinary chronic pain rehabilitation

The improved management of pain among the growing number of female Veterans receiving care through the Veterans Health Administration has been established as a priority, but studies suggest that females may respond differently to pain treatment. This study explored differences between female and male Veterans engaged in a Chronic Pain Rehabilitation Program and determined how female and male Veterans change following participation. Veterans (N = 324) in a 3 wk inpatient program completed self-report measures at admission, discharge, and 3 mo follow-up. Participants were 21% female (n = 67) and 79% male (n = 257). Compared with males, females were younger and less likely to be white or married/partnered. Females reported shorter pain duration and were more likely to have primary head or limb pain. At admission, fewer females were prescribed opioids than males and at lower doses. After opioid cessation in the program, however, there were no significant differences in use between the sexes at follow-up. Improvements in a range of domains were sustained at follow-up for both sexes, but females did not maintain gains in pain intensity or sleep while males reported more pain-related fear at discharge and follow-up. This study adds to the literature on sex-specific variations in chronic pain and implications for treatment.

(522) The effect of psychiatric comorbidities on treatment outcomes of veterans participating in an interdisciplinary chronic pain rehabilitation program

Psychiatric comorbidities have been shown to adversely affect chronic pain and its treatment, but research is limited regarding its impact on different treatment approaches, particularly interdisciplinary chronic pain rehabilitation. Research on this topic involving veterans is minimal. This study examined the effects of psychiatric comorbidities on veterans’ response to an interdisciplinary outpatient chronic pain rehabilitation program (OCPRP). One hundred patients who completed a VA OCPRP were randomly selected. Participants with psychiatric diagnoses were identified and categorized into one of two groups. Group 1 consisted of 21 patients with no psychiatric diagnoses, and Group 2 included 24 patients with 2 or more psychiatric diagnoses. The 2 groups did not differ on any baseline characteristics, with the exception of non-pain-related psychiatric medications. Patients completed the Pain Outcomes Questionnaire (POQ) and Sleep Problems Questionnaire at intake and discharge, measuring pain intensity, vitality, pain-related negative mood, mobility, pain-related fears, activities of daily living (ADLs), and sleep impairment, with opioid usage also monitored. A MANOVA demonstrated a significant main effect for Time and Group, with a trend effect for the Time x Group interaction (p < .1). Univariate ANOVA’s showed a significant (p < .05) main effect for the Time and Group factors on all POQ and sleep subscale measures except ADLs. Significant Time x Group interactions were also found, with Group 2 patients showing higher pre-and post-treatment scores for negative mood, vitality, and fear, as well as significantly less improvement at discharge in pain, negative mood, and mobility. No significant differences were observed between groups regarding opioid usage. These findings suggest that psychiatric comorbidities have a significant effect on pain rehabilitation treatment outcomes among veterans. Additional research with larger samples, objective measures of functioning, better controls for non-pain psychiatric medications, and longer term follow-up is warranted. Psychiatric comorbidities have been shown to adversely affect chronic pain and its treatment, but research is limited regarding its impact on different treatment approaches, particularly interdisciplinary chronic pain rehabilitation. Research on this topic involving veterans is minimal. This study examined the effects of psychiatric comorbidities on veterans’ response to an interdisciplinary outpatient chronic pain rehabilitation program (OCPRP). One hundred patients who completed a VA OCPRP were randomly selected. Participants with psychiatric diagnoses were identified and categorized into one of two groups. Group 1 consisted of 21 patients with no psychiatric diagnoses, and Group 2 included 24 patients with 2 or more psychiatric diagnoses. The 2 groups did not differ on any baseline characteristics, with the exception of non-pain-related psychiatric medications. Patients completed the Pain Outcomes Questionnaire (POQ) and Sleep Problems Questionnaire at intake and discharge, measuring pain intensity, vitality, pain-related negative mood, mobility, pain-related fears, activities of daily living (ADLs), and sleep impairment, with opioid usage also monitored. A MANOVA demonstrated a significant main effect for Time and Group, with a trend effect for the Time x Group interaction (p < .1). Univariate ANOVA’s showed a significant (p < .05) main effect for the Time and Group factors on all POQ and sleep subscale measures except ADLs. Significant Time x Group interactions were also found, with Group 2 patients showing higher pre-and post-treatment scores for negative mood, vitality, and fear, as well as significantly less improvement at discharge in pain, negative mood, and mobility. No significant differences were observed between groups regarding opioid usage. These findings suggest that psychiatric comorbidities have a significant effect on pain rehabilitation treatment outcomes among veterans. Additional research with larger samples, objective measures of functioning, better controls for non-pain psychiatric medications, and longer term follow-up is warranted.

(525) Efficacy and prediction of pain, mood, and function outcomes upon completion of an interdisciplinary chronic pain rehabilitation program.

Chronic pain renders many individuals incapacitated and increases the risk of opioid dependence throughout the lifetime course of treatment. The efficacy of an intensive non-opioid interdisciplinary chronic pain rehabilitation program (CPRP) was previously established in headache patients1 and was expanded to include a broader range of primary pain conditions in this study. Assessments of pain intensity (0-10), Depression Anxiety Stress Scale (DASS) and Perceived Stress Scale (PSS) scores (measuring mood), Pain Disability Index scores (PDI; measuring function), and coping styles, utilizing the brief COPE questionnaire were compared in 133 patients at admission versus discharge. Statistical and clinically significant improvements, in addition to the predictive potential of patient characteristics and baseline pain, mood, and function, were investigated using repeated measures, paired t-tests, binary logistic regression, and ANOVA. Depression (18.4±11.1 v. 6.8±7.3), anxiety (12.4±9.9 v. 5.9±6.7), disability scores (44.0±1.0 v. 21.3±14.9), and pain (6.8±2.1 v. 3.6±2.5) were significantly reduced over the course of CPRP (p<0.001). Marital status (Wilks’ Lambda= 0.89, F(4,228)=3.407, p=0.010) and primary pain condition (Wilks’ Lambda= 0.83, F(12,228)=1.925, p=0.033) impacted mood with the most significant improvement in depression of single individuals and anxiety of fibromyalgia patients. Clinically significant improvement of at least one level of depression was enhanced by acceptance type coping and was diminished by substance abuse coping, higher disability levels, and post-traumatic stress disorder symptoms at admission (X2(4)=32.6, p<0.001). Older age, single status, and planning style coping at admission predicted clinically lower disability by discharge (X2(4)=15.2, p=0.004). Improvement of pain and anxiety level were negatively impacted by each additional year of chronic pain an individual had already experienced (X2(1)=5.9, p=0.015 and X2(1)=11.0, p=0.001). Taken together, this study indicates the potential pain, mood, and function benefit of an interdisciplinary program and may enable improved risk stratification and personalization of chronic pain treatment. (1. Zheng, Headache, 2013.) Chronic pain renders many individuals incapacitated and increases the risk of opioid dependence throughout the lifetime course of treatment. The efficacy of an intensive non-opioid interdisciplinary chronic pain rehabilitation program (CPRP) was previously established in headache patients1 and was expanded to include a broader range of primary pain conditions in this study. Assessments of pain intensity (0-10), Depression Anxiety Stress Scale (DASS) and Perceived Stress Scale (PSS) scores (measuring mood), Pain Disability Index scores (PDI; measuring function), and coping styles, utilizing the brief COPE questionnaire were compared in 133 patients at admission versus discharge. Statistical and clinically significant improvements, in addition to the predictive potential of patient characteristics and baseline pain, mood, and function, were investigated using repeated measures, paired t-tests, binary logistic regression, and ANOVA. Depression (18.4±11.1 v. 6.8±7.3), anxiety (12.4±9.9 v. 5.9±6.7), disability scores (44.0±1.0 v. 21.3±14.9), and pain (6.8±2.1 v. 3.6±2.5) were significantly reduced over the course of CPRP (p<0.001). Marital status (Wilks’ Lambda= 0.89, F(4,228)=3.407, p=0.010) and primary pain condition (Wilks’ Lambda= 0.83, F(12,228)=1.925, p=0.033) impacted mood with the most significant improvement in depression of single individuals and anxiety of fibromyalgia patients. Clinically significant improvement of at least one level of depression was enhanced by acceptance type coping and was diminished by substance abuse coping, higher disability levels, and post-traumatic stress disorder symptoms at admission (X2(4)=32.6, p<0.001). Older age, single status, and planning style coping at admission predicted clinically lower disability by discharge (X2(4)=15.2, p=0.004). Improvement of pain and anxiety level were negatively impacted by each additional year of chronic pain an individual had already experienced (X2(1)=5.9, p=0.015 and X2(1)=11.0, p=0.001). Taken together, this study indicates the potential pain, mood, and function benefit of an interdisciplinary program and may enable improved risk stratification and personalization of chronic pain treatment. (1. Zheng, Headache, 2013.)

Attachment insecurity predicts responses to an interdisciplinary chronic pain rehabilitation program.

The aim of this study was to examine the hypothesis that attachment insecurity is associated with poorer responses to interdisciplinary treatment for chronic pain. Patients (n = 235) admitted to a 4-week interdisciplinary rehabilitation program were recruited. At pre-treatment, participants completed a battery of questionnaires assessing adult attachment styles and dimensions, as well as pain intensity, disability, self-efficacy, pain catastrophizing, and depressive symptoms. The latter measures were completed again at post-treatment. Nearly two-thirds of participants (65.5 %) reported having an insecure attachment style. Attachment insecurity was unrelated to pre- and post-treatment reports of pain intensity and pain-related disability, but was significantly associated with most other clinical variables at both time points. Regression analyses controlling for pre-treatment functioning indicated that attachment insecurity was associated with less improvement in pain catastrophizing, pain self-efficacy, and depressive symptoms. Further research is warranted to investigate the processes by which attachment characteristics influence patients' responses to chronic pain rehabilitation.

Variability in the Relationship Between Sleep and Pain in Patients Undergoing Interdisciplinary Rehabilitation for Chronic Pain

Chronic pain and sleep disturbance frequently coexist and often complicate the course of treatment. Despite the well-established comorbidity, there are no studies that have investigated concurrent changes in sleep and pain among patients participating in an interdisciplinary chronic pain rehabilitation program (ICPRP). The goal of this study was to investigate the daily changes in sleep and pain among patients participating in an ICPRP. Multilevel modeling techniques were used to evaluate the daily changes in total sleep time (TST) and pain among a sample of 50 patients with chronic noncancer pain participating in the ICPRP. Increases in TST were predictive of less pain the following treatment day, although daily pain ratings were not predictive of that night's TST. Time in treatment was a significant predictor of both TST and pain reduction, even while controlling for age, gender, anxiety, and depression. Additional analyses revealed significant individual variability in the relationship between TST and next day pain. Individuals with stronger associations between previous night's TST and next day pain were found to experience the greatest treatment benefits overall, in terms of pain reduction and TST. Our results provide compelling support for individual variability of the pain-sleep relationship in patients with intractable pain conditions participating in an ICPRP. Importantly, these findings suggest that when pain and sleep are comorbid, both must be addressed to reap the maximum response to treatment programs such as an ICPRP. This study demonstrates the utility of treating sleep problems in patients participating in an interdisciplinary chronic pain rehabilitation program. Results highlight the benefits of accounting for individual variability in the pain-sleep relationship in a clinical setting and targeting sleep interventions for those individuals whose pain and sleep problems are comorbid.

(553) Treatment outcomes of patients with chronic abdominal pain within an interdisciplinary chronic pain rehabilitation program

Studies examining treatment outcomes among patients with chronic noncancer pain treated in interdisciplinary chronic pain rehabilitation programs (CPRP) are abundant, however outcome studies specific to patients with abdominal pain are virtually non-existent. This retrospective study examined the outcomes of patients with abdominal pain treated in the Cleveland Clinic’s CPRP. Outcomes included pain severity, depression, anxiety and pain related functional impairment and were measured at both admission and discharge.

(563) Treatment success of older adults with chronic pain at an interdisciplinary chronic pain rehabilitation program

(563) Treatment success of older adults with chronic pain at an interdisciplinary chronic pain rehabilitation program