Multidisciplinary Pain Management Program Research Articles

What Influences Outcomes From Inpatient Multidisciplinary Pain Management Programs?: A Systematic Review and Meta-analysis.

Although inpatient multidisciplinary pain management programs (PMPs) are effective for chronic pain, not all patients benefit equally and there is limited evidence regarding predictors of outcome. This meta-analysis aimed to identify patient or program characteristics associated with outcomes from inpatient PMPs, and to examine the time course of effects following discharge. Medline, EBSCO, and Scopus were searched to identify articles reporting outcomes from inpatient multidisciplinary PMPs. Information was extracted on study design, participant and program characteristics, and outcomes. Effect sizes were computed for pain, physical function, depression, anxiety, and mental health outcomes. Study-level predictors of outcome were investigated with moderator analyses and meta-regression. A risk of bias assessment and sensitivity analyses were conducted and the GRADE criteria for prognostic studies were applied to assess confidence in findings. In all, 85 studies (111 cohorts; 15,255 participants) were included. Three quarters of studies demonstrated low risk of bias. Larger effect sizes (for at least 1 outcome measure) occurred in studies where participants had more severe pain (greater intensity/longer duration), participants with alcohol or drug problems were not excluded, samples comprised mixed pain conditions, and programs included a cognitive component and/or a passive therapy component. Effect sizes for pain and physical function were maintained at follow-up, but effect sizes for depression and anxiety declined over time. Inpatient multidisciplinary PMPs may be well suited to patients with severe or long-lasting pain. Programs should adopt broad patient inclusion criteria, and outcomes were similar for programs based on cognitive-behavioral versus mindfulness/acceptance-based therapies.

Clinical and cost-effectiveness of an online-delivered group-based pain management programme in improving pain-related disability for people with persistent pain—protocol for a non-inferiority randomised controlled trial (iSelf-help trial)

IntroductionPersistent non-cancer pain affects one in five adults and is more common in Māori—the Indigenous population of New Zealand (NZ), adults over 65 years, and people living in areas of...

Reduced individual treatment delivery has no effect on outcomes in a multidisciplinary pain management program.

Objective There is little information on how multidisciplinary pain management programs (MPMPs), the gold-standard treatment for people with chronic non-cancer pain, should be structured or delivered. This study compared outcomes from a 3-week in-patient MPMP between those who attended a group-based program that included 8 h of individual therapy each week and those who attended when the amount of individual therapy had been halved. Methods Participants were patients attending an MPMP with a large component of individual sessions (n = 112; Standard) and patients attending the same MPMP after it switched to predominantly group-based sessions (n = 117; Revised). The Hospital Anxiety and Depression Scale (HADS) and Queen Elizabeth (QE) Health Scale were administered to participants at baseline and discharge. Regression analysis was used to compare outcomes between the two delivery formats. Results There were no significant differences in any outcome measures between the two delivery formats overall. The QE Health Scale (P < 0.001) and HADS depression (P < 0.05) scores were significantly better for patients with rheumatoid arthritis or osteoarthritis who had undertaken the Revised program compared with the Standard program. Conclusions This study provides support that changing the amount of individual therapy within in-patient MPMPs does not change patient outcomes. However, there is evidence that those with rheumatoid arthritis and osteoarthritis respond better to a more group-based approach, suggesting that different populations may be suited to different delivery formats. What is known about the topic? Studies have shown mixed results as to whether group- or individual-based rehabilitation programs are more effective. Previous systematic reviews on physiotherapy- or psychological-based interventions have concluded that individual and group approaches are generally equivalent in terms of patient outcomes. MPMPs are trending towards more group-based delivery of content; however, it is unknown whether the equivalence of efficacy between group and individual formats extends to a chronic pain population receiving multidisciplinary care. What does this paper add? This research specifically adds to the knowledge that almost exclusive group delivery of therapy is just as effective as a program with more individual components in a population of patients participating in an MPMP. There is some evidence that those with rheumatoid arthritis and osteoarthritis in the almost exclusive group delivery program had better outcomes than those in the program with more individual components, indicating that specific conditions may benefit more from a group approach. What are the implications for practitioners? Practitioners can be confident that group delivery is just as effective as individual delivery of program components in an MPMP. Thus, decisions regarding the delivery format can be based on factors such as practical considerations, cost or patient and clinician preference.

Self-efficacy as a prognostic factor and treatment moderator in chronic musculoskeletal pain patients attending pain management programmes: A systematic review.

Evidence on the effectiveness of pain management programmes (PMPs) for chronic pain patients is mixed. Self-efficacy may be associated with outcome of PMPs. The purpose of this systematic review was to assess the role of self-efficacy as a (i) prognostic factor and (ii) moderator of treatment, in chronic musculoskeletal pain (CMP) patients attending a PMP. A systematic review of the literature and qualitative synthesis was carried out. Six electronic databases were searched (1989-2020). Studies that measured pain self-efficacy as a prognostic factor or treatment moderator in patients with CMP, who participated in a multidisciplinary PMP were included. Study quality was appraised using the Quality in Prognosis Studies (QUIPS) tool and the Grading of Recommendations Assessment, Development and Evaluation (GRADE) system. Six studies investigating self-efficacy as a prognostic factor were included with a total of 1881 participants. No studies were found assessing self-efficacy as a treatment moderator. Self-efficacy was a prognostic factor for physical functioning in two studies. There was weak evidence for self-efficacy as a prognostic factor for disability, health-related quality of life and pain outcomes and no evidence for psychological variables, disease severity and tender point index following PMPs. Quality of evidence was very low using the GRADE system for each outcome measure. Baseline self-efficacy may play a role in physical function outcomes in CMP patients attending a PMP. Higher quality evidence is needed to determine the influence of self-efficacy on outcomes in this setting.

Optimizing telehealth pain care after COVID-19.

Optimizing telehealth pain care after COVID-19.

Knowledge and attitudes of pediatric clinicians regarding pediatric pain management

The professional knowledge and personal attitudes of pediatric clinicians regarding pediatric pain are the most important factors impacting pediatric pain relief care. Few studies have investigated the knowledge and attitudes regarding pediatric pain management of clinicians in Taiwan. Research purposes were to evaluate the knowledge and attitudes of pediatric clinicians regarding pain management and to describe the barriers of applying pain management across pediatric and neonatal settings. A cross-sectional descriptive comparative design was used. Pediatric clinicians from two medical centers and three general hospitals in Taiwan were recruited to complete a questionnaire. A total of 264 clinicians participated. On 33 questions measuring knowledge of pain management, the average correct response rate was 23.67. A significantly positive relationship was identified between clinicians' knowledge and prior training experience. Professional degree attainment significantly impacted clinicians' attitudes about pediatric pain management. Clinicians at pediatric wards showed more positive attitudes than did clinicians at either pediatric intensive care units or neonatal intensive care units. Five barriers to pediatric pain management were found. The findings of this study suggest that pediatric clinicians in Taiwan need further education regarding pediatric pain management. This study will also helpful in implementing multidisciplinary pediatric pain management programs to improve the quality of pediatric practice in pediatric care settings of hospitals.

Individuals perspectives related to acceptance, values and mindfulness following participation in an acceptance-based pain management programme

There is a growing body of evidence supporting the effectiveness of Acceptance and Commitment Therapy (ACT) for chronic pain. However, individuals' experiences and opinions of ACT and the underlying processes have rarely been examined. The aim of this study was to explore patients’ views, in relation to the processes acceptance and values, in addition to mindfulness, which is a core construct of ACT. A qualitative study was conducted with individuals, following attendance of a multidisciplinary pain management programme that included education, exercise and ACT-based psychology sessions. The study comprised of four semi-structured focus group interviews with eleven participants. Focus groups were audio-recorded and transcribed verbatim. A thematic analysis was performed and five main themes were identified: (1) Acceptance, with three sub-themes noted in relation to the process of acceptance: (i) an initial strong emotional reaction, (ii) evolving perspectives (iii) non-acceptance; (2) chronic pain beliefs; (3) empathy and validation; (4) values, with three sub-themes including (i) family and self-care, (ii) social activity, (iii) work and (5) being in the moment. This study provides new insights into the perspectives of individuals who have taken part in a multidisciplinary pain management programme, which included ACT-based psychology sessions. Factors which influenced engagement with the core processes underlying this therapeutic model are discussed.

Exercise and Acceptance and Commitment Therapy for Chronic Pain: A Case Series with One-Year Follow-Up.

There is growing evidence to support Acceptance and Commitment Therapy (ACT) in the management of chronic pain. However, there is a need for further research evaluating ACT combined with physical exercise, and few studies have assessed the long-term impact of this type of intervention. This case series reports on the acceptability and impact of an ACT-based multidisciplinary pain management programme on a range of health outcomes in both the short and long-term. Seventy-three participants completed an 8-week group-based, pain management programme. The programme combined weekly sessions of ACT with education and exercise classes. Self-report outcome measures were completed at baseline, post-intervention and at one-year follow-up. The measures assessed pain intensity and interference, psychological distress, self-efficacy, pain acceptance, values-based action, pain catastrophizing, fear avoidance and healthcare utilization. Pedometers were worn to objectively measure physical activity. Data were analyzed using linear mixed modelling. Ethical approval for this study was granted by the Mater Misericordiae University Hospital (MMUH) Institutional Review Board (Reference 1/378/1541). Eighty-six percent of respondents reported being satisfied with the intervention. Improvements were observed in most of the self-report outcomes post-intervention and many changes were maintained at one-year. There was also a significant increase in average daily step-count. A pain management programme combining ACT with exercise appears to be an acceptable treatment option for people with chronic pain. While improvements were observed in both the short and long-term, further fully powered RCTs with long-term follow-up are required to test the effectiveness of this type of intervention.

Multidisciplinary Pain Management of Chronic Back Pain: Helpful Treatments from the Patients' Perspective.

Multidisciplinary pain management programs (MPMP) for patients suffering from chronic back pain include a variety of treatment modalities. The patients’ perceived helpfulness of these treatment modalities remains unclear. The aims of this prospective observational cohort study were to assess (i) the patients’ perceived helpfulness of different treatment modalities, (ii) the influence of sociodemographic characteristics on the patient’s perspective and (iii) whether treatment outcomes are affected by helpfulness ratings. Treatment modalities of this three-week MPMP consisted of individual physiotherapy, group-based physiotherapy, relaxation therapy, aquatic therapy, back education, medical training therapy, biofeedback, psychological pain therapy and music therapy. The study comprised 395 patients. The main outcome was the patients’ perceived treatment helpfulness at the end of the program measured by a self-reported questionnaire ranging from 1 (not at all helpful) to 6 (extremely helpful). Secondary outcomes were treatment effects on pain, pain related disability, functional ability and level of depressive symptoms measured by self-reported questionnaires (NRS, PDI, FFbH-R, ADS-L). A total of 276 patients (22–64 years, 57% female) were available for overall analysis. Multivariate-analysis-of-variance- (MANOVA-) related results revealed that perceived treatment helpfulness (range 1–6) differed significantly between treatment modalities: individual physiotherapy (M = 5.00), group-based physiotherapy (M = 4.87), relaxation therapy (M = 4.6), aquatic therapy (M = 4.54), back education (M = 4.43), medical training therapy (M = 3.38), biofeedback (M = 3.31), psychological pain therapy (M = 3.15), music therapy (M = 3.02). Pain, pain related disability and levels of depressive symptoms significantly improved after the program (p < 0.001) whereas functional ability decreased (p < 0.01). Significant correlations were found between helpfulness ratings and sociodemographic data indicating that perceived treatment helpfulness was influenced by patient-related factors. Importantly, the degree of pain-related improvements was affected by the patients’ perceived treatment helpfulness. In conclusion, patients’ perceived treatment helpfulness differs significantly between treatment modalities and corresponds to treatment outcome.

Improvements in clinical pain and experimental pain sensitivity after cognitive functional therapy in patients with severe persistent low back pain.

Introduction:Multidisciplinary care is recommended for disabling persistent low back pain (pLBP) nonresponsive to primary care. Cognitive functional therapy (CFT) is a physiotherapy-led individualised intervention targeting psychological, physical, and lifestyle barriers to recovery, to self-manage pLBP.Objectives:This pilot study investigated clinical outcomes and pain thresholds after a 12-week CFT pathway in patients with severe pLBP referred to a University Pain Center. Exploratory analyses compared changes in clinical outcomes, opioid consumption, and costs after CFT with changes after a multidisciplinary pain management (MPM) pathway.Methods:In total, 47 consecutively referred pLBP patients consented to the CFT pathway. At baseline, 3 and 6 months, clinical outcomes and PPTs were assessed. Control patients (n = 99) who had completed an MPM pathway in the last 3 years were matched from the clinical pain registry used in the Pain Center in a 3:1 ratio based on propensity scores derived from relevant baseline variables of the CFT cases.Results:Most clinical outcomes and low back pressure pain threshold were improved at 3 and 6 months after the CFT pathway. Compared with MPM, CFT patients had significantly larger reductions in disability and improved quality of life after the interventions at a lower cost (−3688€ [confidence interval: −3063 to −4314€]). Reduction in pain intensity and proportion of patients withdrawing from opioids (18.2% vs 27.8%) were similar between CFT and MPM groups.Conclusion:Improvements in clinical and experimental pain were found after the CFT pathway. Fully powered randomized controlled trials comparing CFT with an MPM program in patients with disabling pLBP are warranted to control for the current limitations.

Reboot Online: A Randomized Controlled Trial Comparing an Online Multidisciplinary Pain Management Program with Usual Care for Chronic Pain.

Chronic pain is a prevalent and burdensome condition. Reboot Online was developed to address treatment barriers traditionally associated with accessing face-to-face chronic pain management programs. It is a comprehensive multidisciplinary online treatment program, based on an existing and effective face-to-face multidisciplinary pain program (the Reboot program). A CONSORT-compliant randomized controlled trial was conducted, enrolling adults who had experienced pain for three months or longer. Participants were randomly allocated to either an eight-lesson multidisciplinary pain management program, Reboot Online (N = 41), or to a usual care (UC) control group (N = 39). Clinical oversight was provided by a multidisciplinary team remotely, including physiotherapists and clinical psychologists. Participants were measured at baseline, post-treatment (week 16), and three-month follow-up (week 28). Intention-to-treat analyses revealed that Reboot Online was significantly more effective than UC at increasing pain self-efficacy (g = 0.69) at post-treatment, and these gains were maintained at follow-up. Similarly, Reboot Online was significantly more effective than UC on several secondary measures at post-treatment and follow-up, including movement-based fear avoidance and pain-related disability, but it did not significantly reduce pain interference or depression compared with UC. Clinician input was minimal, and adherence to Reboot Online was moderate, with 61% of participants (N = 25) completing all eight lessons. Reboot Online presents a novel approach to multidisciplinary pain management and offers an accessible, efficacious alternative and viable treatment option for chronic pain management.

Psychological Profiles of Patients in a Multidisciplinary Chronic Pain Management Program in Central Taiwan

Many studies have suggested that multidisciplinary care is an effective pain management method; however, this care mode is still not commonly seen in Taiwan. The current study focused on patients within the first multidisciplinary pain management program in Taiwan. The first aim of this study was to investigate the effectiveness of the first multidisciplinary pain management program in Taiwan in terms of improving chronic pain patients' mood, sleep quality, and pain. The second aim was to determine whether improvement in mood or sleep quality was predictive of improvement in pain, and vice versa. Patients from a pain clinic were invited to join a multidisciplinary pain management program. They were assessed each month for improvement in mood, pain, and sleep quality. This study reviewed the medical records of these patients. Twenty male and thirteen female chronic non-malignant pain patients aged between 23 and 64 from a pain clinic. During the first visit, a clinical psychologist assessed the mental health of patients before patients undertook education delivered by nine other professionals in the program. Participants' mood, pain, and sleep quality were assessed monthly. The study used repeated measures analysis of variance to identify changes in patients' mood, pain, and sleep quality after three months of multidisciplinary care. We used linear regression to assess whether changes in mood or sleep quality could predict improvement in pain, and vice versa. The level of anxiety decreased, and sleep quality improved significantly, over the duration of care. The severities of depression and sleep disturbance decreased as the least pain experienced in the past week showed improvement. Improvement in sleep quality was predictive of improvement in least pain. The multidisciplinary pain management program was effective in improving patients' anxiety and sleep quality. Decreased pain brought about improvement in mood. We also found a reciprocal association between improvements in the least pain experienced in the past week and sleep quality.

Multidisciplinary pain management program for patients with chronic musculoskeletal pain in Japan: a cohort study.

IntroductionMultidisciplinary pain management is a useful method for treating chronic musculoskeletal pain. Currently, few facilities in Japan offer multidisciplinary pain treatment, especially in the inpatient setting. We implemented a multidisciplinary pain management program based on International Association for the Study of Pain recommendations. This study described our initial efforts in implementing the program, and reported 3- and 6-month follow-up results.Materials and methodsOur pain management team included orthopedic surgeons, psychiatrists, nurses, physical therapists, clinical psychologists, pharmacists, and nutritionists. The 3-week inpatient pain management program comprised exercise therapy, psychotherapy, and patient education. We evaluated patients using the Brief Pain Inventory (BPI), Pain Catastrophizing Scale (PCS), Pain Disability-Assessment Scale (PDAS), Hospital Anxiety and Depression Scale (HADS), Pain Self-Efficacy Questionnaire (PSEQ), EuroQol Five Dimensions (EQ-5D), and physical examinations (flexibility, muscle endurance, walking ability, and physical fitness). Statistical analyses were performed using paired t-tests and Wilcoxon matched-pairs signed-rank sum tests with Bonferroni correction after the Friedman test.ResultsData for 23 patients were analyzed before and immediately after the program. Statistically significant improvements were seen in BPI, PCS, PDAS, HADS, PSEQ, EQ-5D, flexibility, muscle endurance, walking ability, and physical fitness. Eight patients were also assessed 3 and 6 months after the program. PCS (rumination and helplessness) scores and flexibility showed significant improvement at 3 and 6 months. Significant improvement was seen in PDAS and HADS (anxiety) scores and muscle endurance at 6 months, and in PSEQ scores immediately and at 3 and 6 months.ConclusionOur inpatient pain management program can improve patients’ physical function and ability to cope with chronic musculoskeletal pain, which supports improved quality of life. Our program is currently being expanded to better assist patients with chronic musculoskeletal pain.

How Have Chronic Pain Management Programs Progressed? A Mapping Review.

Multidisciplinary pain management programs (PMPs) were established in the 1970s and are widely regarded as the gold standard management for people with chronic, noncancer pain. However, the recommended content of PMPs is not well described. The aim of the study was to determine the most common content and structure of inpatient PMPs, and describe how these have changed over time. A mapping review was performed of studies incorporating an inpatient PMP. Information on the content, format, structure, clinicians involved, and outcome measures was extracted. Publications were analyzed across 5 decades from the 1970s to the 2010s. One hundred and four studies were included. All programs included physical therapy and psychology components, and most included education. While the physical therapy component did not change substantially, there was a shift from operant conditioning approaches to more cognitive behavioral methods over time, along with a reduction in active medication withdrawal and family involvement. Involvement of physical therapists, physicians, and psychologists remained high in the programs, but the inclusion of nurses and occupational therapists declined from the 2000s. The outcome measures revealed a shift to assessment of quality of life and general health. Some of the content and format of PMPs has evolved over time, largely with developments in psychological approaches, and there is now more of a holistic approach to assessment.

Parallel Pains and Dynamic Dilemmas: Psychodynamic Considerations in Approaching and Managing Chronic Physical Pain.

Chronic physical pain is prevalent condition and has gained considerable attention in the wake of the opioid crisis and epidemic. As a medical phenomenon, it has highlighted significant gaps in healthcare training, finances, clinical service, and administration. The psychodynamic determinants of pain symptoms or the need for analgesia are rarely considered in the medical management of this problem. The specific objective of this article is to offer a general psychodynamic understanding of chronic physical pain. As a psychodynamically oriented, medically informed psychiatrist practicing in a multidisciplinary pain management program, I propose a clinical construct of psychologically rich "parallel pains" to chronic physical pain, and that these pains inform important interpersonal issues dubbed "dynamic dilemmas." Chronic physical pain is defined, clinical examples are provided, and general implications are considered.

Self-efficacy as a prognostic factor and treatment moderator in chronic musculoskeletal pain patients attending pain management programmes: a systematic review

OBJECTIVE Evidence on the effectiveness of pain management programmes (PMPs) for chronic pain patients is mixed. Self-efficacy may be associated with outcome of PMPs. The purpose of this systematic review was to assess the role of self-efficacy as a (i) prognostic factor and (ii) moderator of treatment, in chronic musculoskeletal pain (CMP) patients attending a PMP. METHODS A systematic review of the literature and qualitative synthesis was carried out. Six electronic databases were searched (1989-2020). Studies that measured pain self-efficacy as a prognostic factor or treatment moderator in patients with CMP, who participated in a multidisciplinary PMP were included. Study quality was appraised using the Quality in Prognosis Studies (QUIPS) tool and the Grading of Recommendations Assessment, Development and Evaluation (GRADE) system. RESULTS Six studies investigating self-efficacy as a prognostic factor were included with a total of 1881 participants. No studies were found assessing self-efficacy as a treatment moderator. Self-efficacy was a prognostic factor for physical functioning in two studies. There was weak evidence for self-efficacy as a prognostic factor for disability, health-related quality of life and pain outcomes and no evidence for psychological variables, disease severity and tender point index following PMPs. Quality of evidence was very low using the GRADE system for each outcome measure. CONCLUSION Baseline self-efficacy may play a role in physical function outcomes in CMP patients attending a PMP. Higher quality evidence is needed to determine the influence of self-efficacy on outcomes in this setting.

The context of litigation in evaluating physical and psychological outcomes from pain management programmes.

There has been extensive research in evaluating chronic pain in the context of litigation while considering the implications that it can have on healthcare outcomes and rehabilitation progress. The aim of this article is to present retrospective observational data about the levels of disability and distress reported by patients with ongoing litigation at the start and following a UK-based multi-disciplinary pain management programme (PMP) when compared with those without litigation. Between June 2014 and September 2017, 859 patients attended and completed a 16-day PMP at a tertiary-level National Health Service (UK) pain clinic. Patients were split into two groups: (1) litigation (n = 110) and (2) non-litigation (n = 749). As a part of the assessment procedure, the patients were given a battery of psychological and physical measures to complete over two time points. Patients with litigation are statistically significantly more distressed at assessment but make comparable clinically meaningful change in PMP intervention when compared with a non-litigation sample. A very small proportion of the variance in depression scores post-treatment is accounted for by the context of litigation (0.5%), which may be accounted for by employment status. There was no effect of litigation on physical outcome post-intervention. This article concludes that it is not appropriate to merely assume that the context of litigation results in limited positive psychological and physical outcomes post-PMP. There are some limitations to the clinical sample presented in respect to the conclusions.

Turning Pain into Gain: Evaluation of a Multidisciplinary Chronic Pain Management Program in Primary Care.

ObjectiveTo measure the impact of the multidisciplinary Turning Pain Into Gain program in people experiencing chronic pain of any etiology.MethodsA mixed-methods observational study of 252 participants was used to explore the impact of Turning Pain Into Gain on medication use; quality of life and functioning, as measured by the Pain Self-Efficacy Questionnaire; and self-reported hospitalizations between 2015 and 2016.ResultsResponses from 178 participants showed an increased alignment with Australian pain medication guidelines (e.g., a 7.3% reduction in paracetamol duplication was reported with a concurrent 5.1% rise in the administration of sustained-release paracetamol formulations); improved Pain Self-Efficacy Questionnaire scores from 23.1 (out of a possible score of 60) preprogram to 35.3 postprogram; and a reduction in self-reported hospitalizations from 50 cases in the 12 months preprogram to 11 cases in the 12 months postprogram.ConclusionsPositive medication, Pain Self-Efficacy Questionnaire, and hospitalization changes provide evidence for the broader implementation of similar patient-centered programs to promote more holistic management of diverse types of chronic pain in primary care. Reduced hospitalization reflects potential for this intervention to be cost-effective, which could be investigated further.

Impact of a multidisciplinary pain management program on patient care utilization and cost of care.

ObjectiveChronic pain is a highly prevalent and costly condition with few proven treatment options. Since 2014, Geisinger’s Department of Pain Medicine has implemented the Multidisciplinary Pain Program (MPP), which consists of a 3-day educational seminar followed by 12 months of comprehensive care. This study examines the impact of MPP on care utilization and cost between 2014 and 2016.MethodsA retrospective health insurance claims data analysis covering a 3-year period between January 2013 and December 2016. Among all patients referred to MPP during the period, a subset of those who were Geisinger Health Plan (GHP) members was identified (113 patients). Those who were GHP members and were referred to MPP after December 2016 served as the contemporaneous comparison group (69 patients). GHP’s claims data for the corresponding period were analyzed on a per-member-per-month (PMPM) basis.ResultsMPP was associated with US$754 PMPM reduction in total cost of care including prescription drug costs (P=0.014) and US$846 reduction in total medical cost excluding prescription drugs (P=0.006). These cost savings were attributable to reductions in utilization of high-end diagnostic imaging (52 per-1,000 members-per month; P=0.015) and acute inpatient admissions (20 per-1,000 members-per month; P=0.086).ConclusionPatients enrolled in MPP were less likely to use expensive diagnostic imaging and experienced fewer hospitalizations, resulting in total cost of care savings. These findings are consistent with the expectation that MPP improves health outcomes among patients suffering from chronic pain.

Pilot Trial of the Reboot Online Program: An Internet-Delivered, Multidisciplinary Pain Management Program for Chronic Pain.

Objectives Chronic pain causes significant disability and psychological distress, but barriers often prevent people with pain from engaging in traditional face-to-face pain management programs. Accessible, feasible, and effective alternative treatment options are needed. Methods A prospective, feasibility pilot study was conducted to trial a novel, multidisciplinary online pain management program: the “Reboot Online” program. Twenty participants experiencing pain of at least three months duration were recruited. All participants were enrolled in the “Reboot Online” program, consisting of eight online lessons completed over 16 weeks. Lessons incorporated multidisciplinary input from medical pain specialists, physiotherapists, and psychologists. Participants were assessed at pretreatment, posttreatment, and follow-up using a suite of outcome measures examining pain, disability, catastrophising, self-efficacy, mood, and psychological distress. Results 13 participants completed the program (65% adherence). Following treatment, the participants had significantly improved scores on measures of pain-related disability, self-efficacy, catastrophising thoughts, acceptance of pain, symptoms of depression, and general psychological distress. These findings were retained at three months posttreatment. Participants also reported high levels of acceptability and satisfaction with the program. Discussion This study provides pilot evidence for the feasibility, acceptability, and effectiveness of an online, multidisciplinary pain program: “Reboot Online.” Future investigations will focus on conducting a randomised controlled trial of this innovative and promising treatment for chronic pain. This trial is registered with ACTRN12615000660583.