Interdisciplinary Pain Management Program Research Articles

Does diagnosis matter? Evaluating impact of pediatric chronic pain diagnosis on pain and function.

This study aimed to A) evaluate changes in pain and function following an outpatient interdisciplinary pain management program (IPMP) for children with different chronic pain conditions and B) explore differences in pain and function at baseline and discharge for different diagnoses. A retrospective chart review was performed for 488 children who participated in an outpatient IPMP. Children's pain and physical, social, and emotional functioning were assessed at initial evaluation, discharge, and one-to-two-month follow-up. Patients were stratified by diagnosis (complex regional pain syndrome [CRPS], headache, musculoskeletal pain, visceral pain, and widespread pain) to evaluate differences in pain and functioning at baseline and discharge. Children's pain and function improved from initial evaluation to discharge. Those with headache and musculoskeletal pain exhibited better baseline physical and emotional functioning than other diagnostic groups (p = 0.03; p = 0.005; p = 0.002; p = 0.04). Children with CRPS displayed the worst baseline physical functioning (p = 0.003). Those with widespread pain exhibited the worst baseline emotional functioning at both initial evaluation and discharge (p = 0.009; p = 0.007). Children with CRPS, visceral pain, and widespread pain undergoing treatment in an IPMP exhibited the most impaired baseline functioning, while those with musculoskeletal pain and headache were least impaired. All exhibited improvements in pain and function following the IPMP.

Implementation of an integrated primary care prevention and management program for chronic low back pain (LBP): patient-reported outcomes and predictors of pain interference after six months

BackgroundIntegrated primary care programs for patients living with chronic pain which are accessible, interdisciplinary, and patient-centered are needed for preventing chronicity and improving outcomes. Evaluation of the implementation and impact of such programs supports further development of primary care chronic pain management. This study examined patient-reported outcomes among individuals with low back pain (LBP) receiving care in a novel interdisciplinary primary care program.MethodsPatients were referred by primary care physicians in four regions of Quebec, Canada, and eligible patients received an evidence-based interdisciplinary pain management program over a six-month period. Patients were screened for risk of chronicity. Patient-reported outcome measures of pain interference and intensity, physical function, depression, and anxiety were evaluated at regular intervals over the six-month follow-up. A multilevel regression analysis was performed to evaluate the association between patient characteristics at baseline, including risk of chronicity, and change in pain outcomes.ResultsFour hundred and sixty-four individuals (mean age 55.4y, 63% female) completed the program. The majority (≥ 60%) experienced a clinically meaningful improvement in pain intensity and interference at six months. Patients with moderate (71%) or high risk (81%) of chronicity showed greater improvement in pain interference than those with low risk (51%). Significant predictors of improvement in pain interference included a higher risk of chronicity, younger age, female sex, and lower baseline disability.ConclusionThe outcomes of this novel LBP program will inform wider implementation considerations by identifying key components for further effectiveness, sustainability, and scale-up of the program.

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.

Health literacy and pain neuroscience education in an interdisciplinary pain management programme: a qualitative study of patient perspectives.

Pain neuroscience education is part of interdisciplinary pain management programs (IPMPs). To date, the role of health literacy on patients' understanding of pain neuroscience education has not sufficiently been examined. Drawing on interviews with patients with diverse levels of health literacy, this article explores patient perspectives on pain neuroscience education. Purposively sampled patients from an IPMP were interviewed twice (waiting list and after 4 weeks). A directed qualitative content analysis was performed with the Integrated Conceptual Model of Health Literacy as an analytic framework. Thirteen patients with chronic musculoskeletal pain were interviewed: 4 men and 9 women aged from 21 to 77 years with diverse educational and mostly low health literacy. One participant dropped out after baseline. Some participants gained access to health information actively; others relied on the expertise of their healthcare providers. Most participants did not seem to receive the information in the pain neuroscience education as intended, experienced difficulties with understanding the message, negatively appraised the information, and were not able to apply this in their daily lives. Health literacy levels likely played a role in this. Pain neuroscience education tailored to patients' health literacy levels, information needs, and learning strategies is needed.

An Exploration of Physical Therapy Outcomes and Psychometric Properties of the Patient-Specific Functional Scale Following an Interdisciplinary Pain Management Program.

The Patient-Specific Functional Scale (PSFS) has been used to assess physical functioning in various chronic pain populations. There is a lack evidence for its use with diverse pain populations who have high impact chronic pain (HICP). The primary aim of this study was to assess the psychometric properties of the PSFS with a heterogeneous sample of patients with HICP. A retrospective observational study of prospective functional outcomes collected before and after participation an intensive pain management program (IPMP): (PSFS, Disabilities of the Arm, Shoulder, and Hand; Lower Extremity Functional Scale; Neck Disability Index; Oswestry Disability Index), Multidimensional Patient Impression of Change, pain intensity, pain limitation, and fear avoidance from the charts of 509 IPMP completers. The reliability, validity, and responsiveness of the PSFS were analyzed using Cronbach's alpha, Pearson correlations, and receiver operating characteristic. Significant improvements were found for all outcomes following program participation (all p's <0.0001). Correlations of the PSFS with similar outcomes (convergent validity) were lower than expected (r's 0.16 - 0.33). A low correlation (r=-0.12) with an unrelated measure, fear-avoidance, supported divergent validity. PSFS change score correlations with similar outcome measures ranged from 0.46 to 0.53. The area under the curve values for the PSFS ranged from 0.801 to 0.857 suggesting a moderate ability for the PSFS to detect improvement. The psychometric properties of the PSFS showed mixed support for construct validity but good support for the responsiveness of the PSFS when used with a heterogeneous sample of patients with HICP.

An Observational Study of Outcomes Associated with Virtual Pain Management Programmes Based on Acceptance and Commitment Therapy Implemented During the COVID-19 Pandemic.

In response to COVID-19, virtual, group-based interdisciplinary pain management programmes (PMPs) were rapidly implemented. This included implementing different intensities and formats of virtual PMPs to address a range of patient needs and complexity. This observational study investigated outcomes associated with virtual high and low intensity and pre-neuromodulation PMPs based on Acceptance and Commitment Therapy (ACT) as part of routine care during the pandemic. Depending on patients' needs, participants completed a virtual high- or low-intensity PMP, or a virtual PMP in preparation for neuromodulation, from June 2020 to June 2022. Participants completed standardized measures of pain intensity and interference, work and social adjustment, depression, and pain acceptance before and after treatment. Data from 2018 and 2019 for in-person residential (n=561), outpatient (n=123), and pre-neuromodulation (n=207) PMPs were also examined to provide an historical benchmark of performance. The virtual high-intensity PMP (n=294) showed significant improvements on all variables, with small effects. There were significant improvements with small effects for pain interference, depression, and acceptance for the virtual pre-neuromodulation PMP (n=129). No statistically significant improvements were observed for the virtual low intensity PMP (n=90). The improvements associated with pre-pandemic in-person PMPs were generally larger relative to the virtual PMPs of comparable intensity delivered during the pandemic. These data provide preliminary support for the potential benefits of high, but not low, intensity virtual ACT-based PMPs, including in the context of neuromodulation. Research is needed to maximize the impact of virtual PMPs and match patients with the most appropriate delivery format.

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.

Economic analysis of patient-related effects of an interdisciplinary pain self-management program.

Active Day Patient Treatment (ADAPT) is a well-established 3 week intensive cognitive-behavioural, interdisciplinary pain management program for patients with disabling chronic pain. The aim of this analysis was to conduct an economic analysis of patient-related effects of ADAPT using hospital administrative data, specifically, to compare the costs and health outcomes for patients 1 month after participating in the program, with the preprogram period when they were receiving standard care. This retrospective cohort study included 230 patients who completed ADAPT (including follow-ups) between 2014 and 17 at the Pain Management and Research Centre at the Royal North Shore Hospital in Sydney, Australia. Data on pain-related healthcare utilization and costs before and after the program were assessed. Primary outcome measures were labour force participation for patients' average weekly earnings and cost per clinically meaningful change in Pain Self-efficacy Questionnaire, Brief Pain Inventory (BPI) Severity, and BPI interference scores (n = 224). We estimated patients, on average, earned $59 more each week at 1 month follow-up compared with baseline. The cost per clinically meaningful change in pain severity and interference score based on the BPI severity and BPI interference were AU$9452.32 (95% CI: $7031.76-$12,930.40) and AU$3446.62 (95% CI: $2851.67-$4126.46), respectively. The cost per point improvement and per clinically meaningful change in the Pain Self-efficacy Questionnaire were $483 (95% CI: $411.289-$568.606) and $3381.02, respectively. Our analysis showed a better health outcome, reduced healthcare services' cost, and reduced number of medications taken 1 month after participating in ADAPT.

Predictors of attrition in an interdisciplinary pain management program.

This study sought to investigate the extent to which demographic and clinical characteristics predict which patients drop out of an interdisciplinary pain management program (IPP). Participants (N = 178 outpatients, 18-75 years of age) received treatment for various chronic pain conditions in an IPP (including biopsychosocial assessment, cognitive-behavioral, and physical therapies). Separate logistic regression analyses identified the demographic and clinical variables most predictive of attrition across five domains: (a) demographics, (b) number of medical and non/psychiatric diagnoses, (c) opioid use (yes versus no)/risk of misuse, (d) pain-related cognition and behavior, and (e) physical, social, and mental well-being. Significant predictors from the five domains were integrated in a final multivariable logistic regression model. Among patients exposed to a 4-week IPP, 34% dropped out. In the final model, significant predictors of higher odds of attrition included younger age or being unemployed. Also, patients on opioids at preintervention had higher odds of completing the IPP than patients not on opioids at preintervention. Follow-up analyses revealed 24 of 37 completers (65%) on opioids at preintervention reduced or eliminated use over the course of the IPP. Because findings are limited by sample and design characteristics, they require replication yet offer novel hypotheses for identifying patients at risk of attrition. Specifically, patients with preintervention opioid use (contrasted with opioid dependence) may particularly benefit from an IPP. Patients at highest risk for early dropout can be targeted for specific engagement interventions to promote completion and effectiveness of IPP. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

A Qualitative Study of the Latter Effects of the COVID-19 Pandemic on Patients Living With Chronic Pain.

This qualitative study examined the effects of the COVID-19 pandemic on the lives of patients living with chronic pain (CP). Patients referred to an interdisciplinary pain management program between July and December of 2021 were asked to respond to the question: "How did the COVID-19 pandemic affect your life?" Fifty-four patients provided comments in response to this question. The comments were analyzed using an inductive approach. Ten themes emerged: (1) psychological state, (2) limitations on social life and activities, (3) minimal to no effect, (4) beliefs and opinions associated with COVID-19, (5) family dynamics, (6) healthcare disruptions, (7) pandemic-related fear, (8) changes in work, (9) change in pain, and (10) getting COVID-19. These themes mirror those found during the onset of the pandemic, with the addition of theme #4. Themes demonstrate the challenges experienced by individuals living with CP, in addition to new developments in the latter portion of the COVID-19 pandemic. It is important to understand the ramifications of shutdowns, so we are better able to address issues that occur in their aftermath.

Supplemental Material for Predictors of Attrition in an Interdisciplinary Pain Management Program

Supplemental Material for Predictors of Attrition in an Interdisciplinary Pain Management Program

Mindfulness-Based Interdisciplinary Pain Management Program for Complex Polymorbid Pain in Veterans: A Randomized Controlled Trial

ObjectiveTo evaluate the effects of interdisciplinary pain management on pain-related disability and opioid reduction in polymorbid pain patients with 2 or more comorbid psychiatric conditions. DesignTwo-arm randomized controlled trial testing a 3-week intervention with assessments at pre-treatment, post-treatment, 6-month, and 12-month follow-up. SettingDepartment of Veterans Affairs medical facility. Participants103 military veterans (N=103) with moderate (or worse) levels of pain-related disability, depression, anxiety, and/or posttraumatic stress disorder randomly assigned to usual care (n=53) and interdisciplinary pain management (n=50). All participants reported recent persistent opioid use. Trial participants had high levels of comorbid medical and mental health conditions. InterventionsExperimental arm—a 3-week, interdisciplinary pain management program guided by a structured manual; comparison arm—usual care in a large Department of Veterans Affairs medical facility. Main Outcome MeasuresOswestry Disability Index (pain disability); Timeline Followback Interview and Medication Event Monitoring System (opioid use). Analysis used generalized linear mixed model with all posttreatment observations (posttreatment, 6-month follow-up, 12-month follow-up) entered simultaneously to create a single posttreatment effect. ResultsVeterans with polymorbid pain randomized to the interdisciplinary pain program reported significantly greater decreases in pain-related disability compared to veterans randomized to treatment as usual (TAU) at posttreatment, 6-month, and 12-month follow-up. Aggregated mean pain disability scores (ie, a summary effect of all posttreatment observations) for the interdisciplinary pain program were -9.1 (95% CI: -14.4, -3.7, P=.001) points lower than TAU. There was no difference between groups in the proportion of participants who resumed opioid use during trial participation (32% in both arms). ConclusionThese findings offer the first evidence of short- and long-term interdisciplinary pain management efficacy in polymorbid pain patients, but more work is needed to examine how to effectively decrease opioid use in this population.

Predictors of outcomes following interdisciplinary acceptance and commitment therapy for chronic pain: Profiling psychological flexibility.

BackgroundGrowing evidence demonstrates the benefit of acceptance and commitment therapy (ACT) for people with chronic pain. However, there remain people with chronic pain who do not benefit from ACT, and predicting treatment response is difficult.AimsThis aim of this study was to investigate if baseline psychological flexibility (PF) profiles predict responses to an ACT‐based pain management programme.MethodsData from 415 participants attending an interdisciplinary pain management programme were included. Participants completed measures of PF processes and outcomes pre‐ and post‐treatment. Latent profile analysis was used to identify subgroups of participants based on their baseline PF scores. ANOVAs were conducted to compare subgroups of participants on outcome variables at baseline, and changes from pre‐ to post‐treatment.ResultsThree subgroups of participants were identified: (a) low PF, (b) low openness and (c) high awareness and action. The three subgroups significantly differed on all outcome measures at pre‐treatment, supporting the clinical relevance of these PF profiles. However, participants with different baseline PF profiles did not appear to differ in terms of changes in outcome variables.ConclusionsPeople with chronic pain demonstrate different PF profiles, but appear to respond to ACT similarly regardless of these profiles. Future studies with a more individualized focus are needed to further understand which components of ACT work for whom on which outcome and how.SignificanceThere remain people with chronic pain who do not benefit from acceptance and commitment therapy (ACT), and predicting treatment response is difficult. This is the first study to identify psychological flexibility (PF) profiles along multiple PF processes using latent class analysis, and the first longitudinal study to investigate PF profiles in relation to outcomes in ACT for chronic pain. The findings contribute to the understanding of theoretically consistent predictors of outcomes in ACT, which in turn can inform treatment development.

Long term outcomes of chronic pain patients attending a publicly funded community-based interdisciplinary pain program in the Greater Toronto area: results of a practice-based audit

BackgroundChronic pain management multi/interdisciplinary programs attempt to address all elements of the biopsychosocial model. The primary objective of this retrospective study (based on practice-based audit) was to determine the effectiveness of a patient-centered, comprehensive and intense interdisciplinary pain management program in a publicly funded community-based pain clinic in the Greater Toronto Area.MethodThis retrospective longitudinal study was conducted on 218 carefully selected sequential chronic pain patients, with 158 completing a 3–4-month interdisciplinary program between January 2016 and December 2018. Data collected upon exit, at 6 months and 12 months post-discharge included demographic information, pain characteristics, emotional/functional status obtained by validated instruments and global impression of change (GIC). Additionally, social health outcomes (return to work or school) were retrieved through retrospective chart review. Means of pre-and post-program variables were compared to assess changes of each patient’s “journey”.ResultsPhysical and mental/ emotional health outcomes at exit, 6 months and 12 months post-discharge, showed initial and sustained, statistically and clinically significant improvement from pre-treatment levels, with GIC (much/very much improved) reported as 77%, 58% and 76%, respectively. Additionally, a substantial positive change in social health outcomes was noted particularly in patients on disability (29%), part time workers gaining full time employment (55%), and students (71%) who improved their level of schooling.ConclusionThe study showed that careful patient selection in a community-based publicly funded interdisciplinary pain management program can produce significant improvement in pain, physical, mental/emotional health and social function, with sustained long-term outcomes.

Postural Orthostatic Tachycardia Syndrome (POTS): Characteristics of Youth Enrolled in an Outpatient Interdisciplinary Pediatric Chronic Pain Program

Postural Orthostatic Tachycardia Syndrome (POTS) is a common form of orthostatic intolerance that affects about 3,000,000 people in the United States. For youth, significant functional impairment is noted, especially related to school attendance, limited participation in social and physical activities, and lower quality of life. Although previous research highlights the unique challenges for youth with chronic pain, fewer studies have focused on the clinical presentation of pediatric patients with POTS. This study aimed to explore characteristics of youth with POTS presenting to an interdisciplinary pediatric chronic pain program. Twenty-nine adolescents (14.7 +/- 1.7 years; 79% female) diagnosed with POTS presenting with their caregiver to an initial visit at an interdisciplinary pediatric chronic pain management program at a large Northeastern children's hospital in the United States were asked to complete questionnaires assessing demographic and pain characteristics, pain acceptance, and functional impairment and anxiety (PROMIS; t-scores). Number of visits within the program were gathered from medical record. Youth were primarily Caucasian/White (86.2%), Other (6.9%), AAPI (3.4%) and Mixed Race (3.4%). Youth reported overall low pain acceptance (M=34.1, SD=9.3), moderate anxiety (M=57.1, SD=13.1) and high pain interference (M=63, SD =7.4). Caregivers reported observing moderate anxiety (M=59.1, SD =11.5) and high pain interference (M=65.1, SD=4.6) for youth. Adolescents were observed to attend a wide range of visits within the program, including medical (1.7 +/- 2.5), physical therapy (3.4 +/- 4.9), occupational therapy (.5 +/- 1.7), and psychology (4.3 +/- 3.6). Less is known about youth with POTS who present for treatment. Additionally, youth with POTS meet with multiple doctors before receiving a diagnosis leading to disparities in access to treatment and the type of treatment that is received. Data here highlights that youth with POTS are experiencing significant impairment and more research targeting this population is necessary to improve outcomes. Postural Orthostatic Tachycardia Syndrome (POTS) is a common form of orthostatic intolerance that affects about 3,000,000 people in the United States. For youth, significant functional impairment is noted, especially related to school attendance, limited participation in social and physical activities, and lower quality of life. Although previous research highlights the unique challenges for youth with chronic pain, fewer studies have focused on the clinical presentation of pediatric patients with POTS. This study aimed to explore characteristics of youth with POTS presenting to an interdisciplinary pediatric chronic pain program. Twenty-nine adolescents (14.7 +/- 1.7 years; 79% female) diagnosed with POTS presenting with their caregiver to an initial visit at an interdisciplinary pediatric chronic pain management program at a large Northeastern children's hospital in the United States were asked to complete questionnaires assessing demographic and pain characteristics, pain acceptance, and functional impairment and anxiety (PROMIS; t-scores). Number of visits within the program were gathered from medical record. Youth were primarily Caucasian/White (86.2%), Other (6.9%), AAPI (3.4%) and Mixed Race (3.4%). Youth reported overall low pain acceptance (M=34.1, SD=9.3), moderate anxiety (M=57.1, SD=13.1) and high pain interference (M=63, SD =7.4). Caregivers reported observing moderate anxiety (M=59.1, SD =11.5) and high pain interference (M=65.1, SD=4.6) for youth. Adolescents were observed to attend a wide range of visits within the program, including medical (1.7 +/- 2.5), physical therapy (3.4 +/- 4.9), occupational therapy (.5 +/- 1.7), and psychology (4.3 +/- 3.6). Less is known about youth with POTS who present for treatment. Additionally, youth with POTS meet with multiple doctors before receiving a diagnosis leading to disparities in access to treatment and the type of treatment that is received. Data here highlights that youth with POTS are experiencing significant impairment and more research targeting this population is necessary to improve outcomes.

Using quantitative sensory testing to predict attrition in an interdisciplinary pain management program: a pilot study.

Aim: To determine the extent to which quantitative sensory testing (QST) predicted attrition in an interdisciplinary pain program (IPP). Patients & methods: Participants (n=53) enrolled in an IPP completed pretreatment assessments of QST and the PROMIS-29 quality of life survey. Results & conclusion: Compared with completers, non-completers (24.5%) reported significantly higher pain intensity (7.1, 95% CI [5.8, 8.4] versus 5.4, 95% CI [4.8, 6.1]) and cold hyperalgesia (14.6°C, 95% CI [8.8, 20.4] versus 7.5°C, 95% CI [4.8, 6.1]), with both variables also predicting attrition. This finding highlights a potentially novel and clinically significant use of QST. Higher overall pain intensity and the presence of remote cold hyperalgesia may identify patients at risk for dropping out of an IPP.

Qualitative analysis of long-term chronic pain program management outcomes: Veterans and civilians

LAY SUMMARY This study sought to determine how much patients with chronic pain could be helped to function better long after completing a four-week interdisciplinary pain management program. Comments from 16 Veterans and 23 civilians four months to four years after the end of the program showed 10 common themes: 1) gratefulness for their treatment in the program, 2) improved ability to function, 3) better coping strategies and confidence, 4) empowered to overcome daily challenges, 5) on a path to rehabilitation and recovery, 6) the need for support groups, 7) still had struggles, 8) the need for additional follow-up to maintain gains, 9) wishing they had attended the program sooner, and 10) would recommend the program to others. Veterans’ comments were no different from those of civilians. Results emphasize that Veterans and civilians share a common experience and maintain their benefits from interdisciplinary care in managing chronic pain. On the basis of these findings, clinicians have opportunities to improve quality and apply new services to the program.

Comparison of Motor Vehicle Accident (MVA) Survivors and Non-MVA Pain Patients Attending an Interdisciplinary Pain Management Program

Comparison of Motor Vehicle Accident (MVA) Survivors and Non-MVA Pain Patients Attending an Interdisciplinary Pain Management Program