Interdisciplinary Pain Center Research Articles

Dealing with Difficult Patients: Do Customer Service Initiatives Improve Patient Satisfaction at an Interdisciplinary Pain Center?

Chronic pain patients can be difficult to manage due to complicated medical and psychiatric comorbidities. This study focused on strategies designed to improve patient treatment satisfaction within a tertiary urban hospital‐based pain management center. Information was obtained of monthly patient satisfaction and Press Ganey scores in 2009 based on patient perceptions of staff and telephone access, frequency of returned phone calls, staff empathy and responsiveness, and overall patient experience with their pain treatment. Information was also obtained of the number of formal complaints made to the Patient Relations Department of the hospital. A customer service program designed to target patient's phone access, response to phone calls, improved patient experiences, and service friendliness was initiated in March 2010. Six hundred eleven patients (n = 611) were randomly surveyed 3 months after their treatment between 2009 and 2012 and rates of formal patient complaints were monitored. Thirty‐three (n = 33) staff members were encouraged to attend monthly 1.5‐hour customer service meetings and participate in specialized work teams between March 2010 and December 2012. Patient satisfaction scores rose from a low of 80.3 (average of 83.5%) in 2009 to a high of 91.2 (average 88.9%) in 2012. Annual formal complaints to Patient Relations decreased by 40.5% over 4 years (112 in 2009 to 30 in 2012). Phone abandonment rates also decreased by 20% and the center scored 12% higher than average total practice scores in patient satisfaction based on secret shopper ratings. This study demonstrates that customer service initiatives that engage staff participation and that are designed to target specific improvements in patient satisfaction can effectively change the way pain patients perceive treatment at an interdisciplinary anesthesia‐based pain center.

Dor pélvica crônica não visceral: tratamento multidisciplinar. Relato de caso

JUSTIFICATIVA E OBJETIVOS: A prevalência de dor pélvica crônica no sexo feminino é de aproximadamente 4%, similar à prevalência da enxaqueca (2,1%), asma (3,7%) e dor lombar (4,1%). Seu diagnóstico e tratamento constitui um grande desafio para a equipe de saúde. Este estudo teve por objetivo mostrar a dificuldade no diagnóstico e tratamento de dor pélvica crônica e a importância da equipe multidisciplinar no alívio do quadro doloroso. RELATO DO CASO: Paciente de 45 anos, com quadro de dor pelviperineal há 6 anos, após histeroscopia para exérese de pólipo uterino. A dor que iniciou no pós-operatório imediato, de forte intensidade, evoluiu ao longo desse período sem melhora e motivou-a a buscar o Ambulatório de Dor Abdominal, Pélvica e Perineal Crônica do Centro Interdisciplinar de Dor do Hospital de Clínicas da Faculdade de Medicina da Universidade de São Paulo. CONCLUSÃO: O tratamento multidisciplinar que abrangeu o uso de fármacos, inativação dos pontos-gatilho (infiltração com anestésicos, agulhamento seco, acupuntura), fisioterapia, reeducação postural e suporte psicossocial, proporcionou melhora significativa da dor e da qualidade de vida da paciente.

The Impact of Psychological Factors on Outcomes for Spinal Cord Stimulation: An Analysis with Long-term Follow-up

Background: For more than 3 decades, spinal cord stimulation (SCS) has successfully been employed to treat neuropathic pain. Psychological factors are assumed to be important for the efficacy of SCS. However, the impact of psychological factors on the outcome of SCS has only rarely been studied. Objectives: The aim of this study was to determine the influence of psychological factors such as anxiety and depression, perceived disability, and self efficacy on the outcome of SCS in a representative clinical sample. Study design: Retrospective study. Setting: Academic university interdisciplinary pain center. Methods: We reviewed the records of 60 consecutive patients who had been treated at our institution with lumbar, thoracic, or cervical neurostimulators between July 1, 2008, and June 30, 2012. Information with respect to age, gender, diagnosis, age at time of implantation, disease duration, the preoperative Hospital Anxiety and Depression Test, German Version (HADS-D), the Pain Disability Index (PDI) and preoperative pain scores on an 11 point Numeric Rating Scale (NRS) were recorded. In addition, a questionnaire was mailed to participants that contained the following items: pain scores on the NRS with and without stimulation, time intervals of stimulation, paresthesia coverage, treatment satisfaction and medication intake, anxiety/depression (HADS-D and Beck Depression Index II [BDI-II]), PDI, and self efficacy using the Fragebogen zur Erfassung der schmerzspezifischen Selbstwirksamkeit (FESS). Results: Preoperative HADS-D, PDI, and NRS pain scores were not different in those patients with an unsuccessful trial and those who underwent IPG implantation. Long-term outcomes were not affected by pre-implantation HADS-D or PDI scores. FESS scores showed a strong inverse correlation with HADS-D, BDI-II, and PDI scores and showed a tendency towards correlation with the percentage of pain reduction. HADS-D and PDI scores improved after SCS therapy. Limitations: Retrospective study. Conclusion: The outcome of SCS therapy could not be predicted on the basis of tested psychological factors anxiety/depression and pain-related disability. FESS correlated inversely with HADS-D, BDI-II, and PDI scores and showed a tendency towards correlation with the percentage of pain reduction. Further research is needed to define the impact of psychological factors on SCS outcomes. Key words: Spinal cord stimulation, clinical efficacy, paresthesia, psychological factors, anxiety, depression, disability, self-efficacy

Dealing with difficult patients: customer service initiatives at an interdisciplinary pain center

Dealing with difficult patients: customer service initiatives at an interdisciplinary pain center

Long-Term treatment of a patient with severe restless legs syndrome using intrathecal morphine

Restless legs syndrome (RLS) is a common sensorimotor disorder.(1) The symptoms have a strong circadian rhythmicity and are most severe at night and at rest. In the most severe cases, symptoms are accompanied by serious sleep disturbances and unbearable paresthesias. First-line treatments of RLS are dopamine agonists, but GABAergic anticonvulsants and opioids are also effective.(2,3) Patients with the most severe RLS are often treated with oral opioids.(4) The use of these may, however, be limited due to side effects. The intrathecal administration of opioids results in better pain relief and fewer side effects in severe chronic pain. Case reports of 4 patients have documented excellent results with short-term use of intrathecal opioids also in RLS.

Treatment of localized neuropathic pain after disk herniation with 5% lidocaine medicated plaster

ObjectiveTo assess treatment with the 5% lidocaine medicated plaster for peripheral neuropathic pain after disk herniation.Study designCase series, single center, retrospective data.Patients and methodsData of 23 patients treated for neuropathic pain with the lidocaine plaster for up to 24 months after a protrusion or prolapse of the cervical, thoracic, or lumbar vertebral disks were retrospectively analyzed. Changes in overall pain intensity, in intensity of different pain qualities and of allodynia and hyperalgesia were evaluated.ResultsPatients (14 female/nine male, mean age 53.5 ± 10.4 years) presented with radiating pain into the abdomen, back, neck, shoulder, or legs and feet with a mean pain intensity of 8.3 ± 1.5 on the 11-point Likert scale. Mean treatment duration was 7.6 months; 52% of the patients received lidocaine plaster as monotherapy. At the end of the observation, mean overall pain intensity had been reduced to 3.1 ± 1.8. All other parameters also improved. The treatment was well tolerated.ConclusionThese results point to a safe and effective treatment approach with 5% lidocaine medicated plaster for localized neuropathic pain related to disk herniation. However, owing to the small sample size, further investigation in a larger-scale controlled trial is warranted.

Cervical Spinal Cord Stimulation: An Analysis of 23 Patients with Long-term Follow-up

Background: For more than 3 decades, spinal cord stimulation has successfully been employed to treat neuropathic pain. Cervical spinal cord stimulation, despite now being standard in many hospitals, has only rarely been subjected to a critical review within the literature. Objectives: The aim of this study was to determine the efficacy of cervical spinal cord stimulation (SCS) in a representative clinical sample. We also wanted to evaluate how factors such as stimulation parameters, unwanted paresthesia of the trunk and legs, and changes in paresthesia status due to head movement and how they affect SCS effectiveness. Study design: Retrospective study. Setting: Academic university interdisciplinary pain center. Methods: We reviewed the records of patients who had been treated at our institution with cervical neurostimulators from November 1, 2001 through October 31, 2011. Information regarding age, gender, diagnosis, age at time of implantation, duration of disease, lead position, hardware in use, revision operations, and stimulation parameters were recorded. In addition, a short telephone interview was conducted, which contained the following items: pain scores on the numeric analog scale (NAS) with and without stimulation, time intervals of stimulation, paresthesia coverage, changes in paresthesia coverage by head movements, unwanted paresthesia of the trunk and legs, treatment satisfaction, and medication intake. Results: Twenty-three patients were treated. Eighteen patients proceeded to an implantable pulse generator (IPG) implant. In one patient, the system was removed after 4 years despite optimal function, because the patient was no longer experiencing pain. Average NAS pain scores were 6.8 (range 5.5 - 10.0, standard deviation [SD] 1.7) without, and 2.8 (range 0 - 7.5, SD 2.2) with neurostimulation. Fourteen revisions (5 due to lead dislocation, 5 due to lead breakage and 4 IPG revisions) were necessary in 9 of the 18 patients during a mean follow-up of 6.2 years. Most patients reported complete paresthesia coverage. Four patients reported unwanted paresthesia of the trunk or lower limb and 11 patients reported changes in paresthesia with head movements. In both instances, pain reduction was not affected. Limitations: Retrospective study. Conclusions: Cervical spinal cord stimulation appears to be effective in the treatment of neuropathic upper limb pain. Complications are not significantly more frequent than in SCS for lower limb pain. Changes in paresthesia with head movements and unwanted paresthesia did not affect the outcome. Key words: Spinal cord stimulation, cervical, neuropathic pain, clinical efficacy, paresthesia, paresthesia coverage, changes in paresthesia, brachial plexus lesion, nerve root avulsion, stimulation parameters

Accountable disease management of spine pain

The health care landscape has changed with new legislation addressing the unsustainable rise in costs in the US system. Low-value service lines caring for expensive chronic conditions have been targeted for reform; for better or worse, the treatment of spine pain has been recognized as a representative example. Examining the Patient Protection and Affordable Care Act and existing pilot studies can offer a preview of how chronic care of spine pain will be sustained. Accountable care in an organization capable of collecting, analyzing, and reporting clinical data and operational compliance is forthcoming. Interdisciplinary spine pain centers integrating surgical and medical management, behavioral medicine, physical reconditioning, and societal reintegration represent the model of high-value care for patients with chronic spine pain.

An Evaluation of the Long-Term Treatment Outcomes of an Interdisciplinary Chronic Pain Centre Program

ObjectivesThe purpose of this study was to re-evaluate clients of a chronic pain center treatment program at least one year following their completion of the program to determine whether they had maintained improvements and to compare them to a group of clients who underwent the initial assessment but did not attend the treatment program.MethodsThe Chronic Pain Center, located in a mid-size Canadian city, offers an interdisciplinary treatment program. They had documented statistically significant improvement on several measures at the completion of the program but had no formal evaluation of longer-term effects. All clients assessed between 2004 and 2007 were invited to complete an evaluation by mail-out questionnaires, resulting in 142 participants [treatment group = 88, comparison group = 54].ResultsThe treatment group demonstrated significant improvement from assessment to discharge on all outcome measures. These improvements declined over time but remained significantly improved from the admission...

Chronic low back pain: course of disease from the patient’s perspective

Chronic back pain often leads to permanent disability and-apart from significant human suffering-also creates immense economic costs. There have been numerous epidemiological studies focussing on the incidence and the course of chronic low back pain. Less attention has been paid to the impact of subjective perception of the disease and the degree of healthcare use of these patients. The aim of this study was to gather data about patients with chronic low back pain and compare these data with patients suffering from chronic pain in other body regions. The first 300 pain questionnaires collected by the interdisciplinary pain centre at the University Hospital in Freiburg between January 2000 and September 2001 were analysed. This pain questionnaire is a modified version of the pain questionnaire of the DGSS (Deutsche Gesellschaft zum Studium des Schmerzes-German Chapter of the IASP). It collects demographic and socioeconomic information, as well as information regarding the course of the disease, and the subjective description of pain and the pain-related impairment. The subjective view of the course of disease, shows differences between patients with low back pain and patients with chronic pain of other origin, particularly regarding physical strain as the assumed cause of pain, but also regarding the frequency of prior treatments and cures. The subjective perception of the course of the pain disorder in patients with low back pain compared to patients with chronic pain in other parts of the body shows differences mainly related to the capacity for physical exertion. The frequency of ineffective prior treatments and cures underlines the necessity for early initiation of effective pain treatment aimed at prevention of the pain disorder becoming chronic.

The role of fear-avoidance and helplessness in explaining functional disability in chronic pain: a prospective study

Based on the fear-avoidance and helplessness models, the relative contribution of fear of pain, avoidance behavior, worrying, and helplessness were examined in relation to fluctuations in functional disability in chronic-pain patients. A cohort of 181 chronic-pain patients first completed various questionnaires and kept a 7-day pain journal during a standard 3-month waiting-list period prior to their scheduled treatment at an Interdisciplinary Pain Centre and did so again immediately preceding the intervention. At baseline, fear of pain, avoidance behavior, and helplessness all predicted functional disability after 3 months. Stepwise regression analyses showed avoidance behavior to be the strongest predictor of change in functional disability followed by helplessness, thus both ahead of fear of pain. The current findings support the roles of both fear-avoidance factors and helplessness in the functional disability in chronic-pain patients awaiting treatment but revealed a central role for avoidance behavior.

704 OXYCODONE IN DAILY PRACTICE – FULFILLING UNMEET NEEDS AND ADRESSING INDIVIDUAL EXPECTATIONS OF PATIENTS SUFFERING FROM SEVERE CHRONIC PAIN

European Journal of PainVolume 10, Issue S1 p. S184-S184 704 OXYCODONE IN DAILY PRACTICE — FULFILLING UNMEET NEEDS AND ADRESSING INDIVIDUAL EXPECTATIONS OF PATIENTS SUFFERING FROM SEVERE CHRONIC PAIN G. Mueller-Schwefe, G. Mueller-Schwefe DGS, Interdisciplinary Pain Center, GoeppingenSearch for more papers by this authorM.A. Ueberall, M.A. Ueberall IFNAP, Institute for Neurological Sciences, Nuernberg, GermanySearch for more papers by this author G. Mueller-Schwefe, G. Mueller-Schwefe DGS, Interdisciplinary Pain Center, GoeppingenSearch for more papers by this authorM.A. Ueberall, M.A. Ueberall IFNAP, Institute for Neurological Sciences, Nuernberg, GermanySearch for more papers by this author First published: 13 January 2012 https://doi.org/10.1016/S1090-3801(06)60707-6Citations: 1Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinkedInRedditWechat No abstract is available for this article.Citing Literature Volume10, IssueS1September 2006Pages S184-S184 RelatedInformation

The Role of Helplessness, Fear of Pain, and Passive Pain-Coping in Chronic Pain Patients

The goal of this study was to examine the relative contribution of helplessness, fear of pain, and passive pain-coping to pain level, disability, and depression in chronic pain patients attending an interdisciplinary pain center. One hundred sixty-nine chronic pain patients who had entered treatment at an interdisciplinary pain center completed various questionnaires and a pain diary. Helplessness, fear of pain, and passive pain-coping strategies were all related to the pain level, disability, and depression. When comparing the contribution of the predictors in multiple regression analyses, helplessness was the only significant predictor for pain level. Helplessness and the passive behavioral pain-coping strategies of resting significantly predicted disability. The passive cognitive pain-coping strategy of worrying significantly predicted depression. These findings indicate a role for helplessness and passive pain-coping in chronic pain patients and suggest that both may be relevant in the treatment of pain level, disability, and/or depression.

Development of Interdisciplinary Spinal Interventional Pain Centers

The lifetime prevalence of spinal pain has been reported as 65% to 80% in the neck and low back. In the US each year, 500,000 - 1,000,000 spine surgeries and 2 to 5 million interventional procedures are estimated to be performed. The burden created by chronic pain is enormous on the patient and society. Thus, the somatic, psychological, and physical manifestations of pain must be addressed in the overall assessment and treatment of these patients. A myriad of treatment options exist for patients in pain however, with none of the modalities providing conclusive evidence in their effectiveness. The optimal course of care requires an integrated delivery system involving a variety of specialists. Due to the complexities of diagnosis and management, patients are best managed utilizing a multidisciplinary approach under an umbrella of services offered by a spinal diagnostic and interdisciplinary pain center. This review identifies various pain syndromes and conditions and provides a model for the establishment of an interdisciplinary pain center as well as the resources, guidelines, and infrastructure required for operating a successful pain center in any setting; free-standing, hospital-based, or academic.

Differential and common characteristics of patients with atypical facial pain and craniomandibular dysfunction

Craniomandibular disorders (CMD) and atypical facial pain (AFP) represent a clinical challenge. Whereas CMD patients respond to somatic approaches, somatization should be strictly avoided in AFP. The aim of this study was to establish prognostic criteria to identify an aggravated risk of a chronic course in CMD and AFP. A total of 124 consecutive patients with CMD ( n=108) or AFP ( n=16) were examined by two interdisciplinary academic pain centers. Psychometric evaluation was conducted with standardized questionnaires (SCL-90R, STAXI, modified SBAS-IV). All patients were clinically assessed by a maxillofacial surgeon or specialized dentist. The following variables proved to be significant: age (risk for AFP vs CMD increased by 6% p.a.), decreased dysfunction index (13% higher risk for AFP vs CMD), and low scores concerning outwardly directed anger (12% higher risk for AFP vs CMD). There was no correlation between initial pain intensity and somatic parameters of disease as assessed by the standardized clinical examination. Low educational status proved to be the best predictor ( p<0.001) for patients presenting high initial pain with a marked discrepancy between somatic findings and subjective status. CMD patients differ from AFP patients regarding age, psychosocial isolation, outwardly directed anger, and a decreased dysfunction index. Additionally, initial pain intensity in patients presenting indistinct CMD/AFP can be considered as a valid predictor for a chronic course in pain.

The management of chronic pain in Switzerland: A comparative survey of Swiss medical specialists treating chronic pain

Chronic pain management by Swiss specialist physicians with the primary hypothesis that pain clinic practitioners conform better to good practice (interdisciplinarity, diagnostic/therapeutic routines, quality control, education) than other specialists treating chronic pain was surveyed.Management of all types of chronic pain by pain clinic practitioners and rheumatologists, oncologists or neurologists was compared via a mailed questionnaire survey (n=125/group).Two hundred and twenty-nine (46%) of 500 mailed questionnaires were returned with similar group return rates. Eighty-six percent of responders find chronic pain therapy very difficult/difficult; they estimate only 45% of these patients achieve good outcomes. Twenty-three per cent of responders belong to an interdisciplinary pain centre, but 72% of chronic pain patients are treated by responders alone. Fifty-nine percent never/only occasionally use therapeutic algorithms, 38% use formal pain diagnostic procedures, 20% have a pain quality control programme. Fifty-one percent lack past pain education, 37% do not attend continuing pain education, 69% agree that pain education is their greatest need. Pain clinic practitioners are more interdisciplinary and use more pain diagnostics than other specialists. They are matched by oncologists in education and success in therapeutic escalation, and bettered by them in algorithm use.Pain clinic practitioners and oncologists bring particular—differing—skills to chronic pain management compared to rheumatologists and neurologists. Chronic pain management diversity may result from differences in malignant and benign pain, and its generally being provided by the speciality treating the underlying cause. This survey identifies targets for improvement in areas fundamental to good chronic pain practice: interdisciplinarity, diagnostic/therapeutic tools, quality management and education.

Interdisciplinary Treatment for Chronic Pain: Is It Worth the Money?

Complex problems require complex solutions. As we have seen, chronic pain syndromes are complex biopsychosocial phenomena that develop over time. Conventional medical strategies designed for acute pain are often unhelpful and costly if patients have developed more chronic pain problems. Research studies have suggested that an interdisciplinary team is more effective than either serial multidisciplinary treatments or fragmented approaches toward care. Fortunately, the cost of interdisciplinary care is relatively low. Okifuji et al noted that interdisciplinary pain centers “have been more rigorously examined than most other treatment modalities used with chronic pain patients. More data are available for the efficacy of … [these centers] … than for any surgical procedures or conventional medical treatment for chronic pain” (3). Although time consuming and costly, treatments received at interdisciplinary pain centers “result in greater clinical effectiveness and cost savings than the alternatives” (3).

Predictive validity of the pain and impairment relationship scale in a chronic nonmalignant pain population

Objective: To examine the predictive and incremental validity of the Pain and Impairment Relationship Scale (PAIRS) and to determine its ability to measure changes in pain beliefs following interdisciplinary treatment. Design: A before-after treatment design. Setting: A comprehensive interdisciplinary pain center at a large midwest university medical center. Interventions: A cognitive-behavioral approach to pain management. The day-long program lasted 5 days a week for 4 weeks. Interventions were designed to improve physical functioning, reduce use of health care, and improve pain coping. Main Outcome Measures: Six-month follow-up outcome measures included interference with daily activity, pain severity, and life control as measured by the Multidimensional Pain Inventory, medication use measured by the Medication Quantification Scale, depression measured by the Beck Depression Inventory, and the number of health care visits and pain-related hospitalizations. Results: Pretreatment PAIRS scores correlated significantly with interference with daily activities, pain severity, life control, health care visits, and depression. Stronger correlations were obtained between posttreatment PAIRS scores and all follow-up outcome measures. Posttreatment PAIRS scores accounted for a significant portion of the variance beyond that in demographic variables and pretreatment PAIRS scores in all but one of the follow-up measures. PAIRS scores changed significantly ( p < .0001) in a positive direction after treatment. Conclusions: The PAIRS has excellent predictive validity, and can be used effectively to monitor individual and programmatic changes.