Multidisciplinary Pain Treatment Program Research Articles

Exploring the effects of fitbit incentive on treatment outcomes in veterans undergoing intensive pain rehabilitation program

ObjectiveThis study compares clinical pain outcomes between patients in a pain treatment program that received a Fitbit, to patients that did not. We also explored: (1) cognitive, emotional, and psychological factors that may have impacted the decision to opt in to receiving a Fitbit; and (2) whether the choice to receive a Fitbit impacted changes in cognitive, emotional, and psychological factors following treatment.MethodsAmong 58 patients in a multidisciplinary pain treatment program at a Veterans Affairs Healthcare System hospital, 31 patients opted to receive a Fitbit as adjunct treatment, while 27 did not. This study utilized patient-reported and practitioner-collected data from the pain treatment program.ResultsCompared to the non-Fitbit group, the Fitbit group displayed a significant decrease in average pain intensity, however showed no correlation between Fitbit activity and average pain intensity. Additionally, treatment satisfaction was the only predictor of treatment group, when modeling pre- and post-treatment outcomes changes.ConclusionThe implementation of a Fitbit may lead to improved pain intensity. Initial evidence suggests that opting to receive a Fitbit during a pain treatment program indicates treatment engagement leading to greater treatment satisfaction. Future work is needed to verify and expand upon this potential mechanism.

Obesity and the risk of multiple or severe frequent knee pain episodes: a 4-year follow-up of the ELSA-Brasil MSK cohort.

Knee pain is an important health problem due to its high prevalence, negative impact on daily activities and quality of life, and societal burden. While the link between excess weight and knee pain has been well-documented in the literature, many studies are limited to patients with osteoarthritis or use cross-sectional data. This longitudinal study investigated whether overweight and obesity were associated with the frequency and severity of frequent knee pain (FKP) episodes over 4 years in civil servants enrolled in the ELSA-Brasil MSK cohort. Knee pain was assessed during baseline face-to-face interviews (2012-2014) and four yearly telephone follow-ups (2015-2019). Disabling FKP episodes or those of moderate to very severe intensity were classified as severe. Multinomial logistic regression models adjusted for confounders were used to test for associations in two participant groups: those with knee pain at baseline (prognosis cohort) and those without knee pain (incidence cohort). A total of 2644 participants were included: 54.2% female, mean age 55.8 (SD 8.8) years. In the incidence cohort (n = 1896), obesity increased the risk of one (OR: 1.63; 95% CI 1.13-2.37) and multiple FKP episodes (OR: 2.61; 95% CI 1.71-3.97), as well as the risk of non-severe (OR: 1.72; 95% CI 1.04-2.84) and severe FKP episodes (OR: 2.10; 95% CI 1.50-2.95). In the prognosis cohort (n = 748), obesity increased the risk of multiple (OR: 2.54; 95% CI 1.60-4.05) and severe FKP episodes (OR: 2.31; 95% CI 1.49-3.59). Overweight presented the same trends but fell short of significance. These results provide further support that overweight and obesity are important contributors to the incidence and worsening of FKP, and that weight management must be prioritized in multidisciplinary knee pain prevention and treatment programs to reduce the burden of musculoskeletal disorders.

Seasonal impact on the outcome of multidisciplinary pain therapy

ABSTRACT Multidisciplinary pain treatment programs (MPTP) have been considered to be the most effective treatment of chronic pain. In this study, we analyzed the influence of seasons on the outcome of chronic pain patients undergoing MPTP. Therefore, a prospective, observational trial was conducted in patients with chronic pain undergoing a 5-week interdisciplinary treatment program. Psychological stabilization (measured by ADS – Allgemeine Depressionsskala) and pain levels (measured by NRS – numeric rating scale) were considered as primary endpoints. As a result of this study, we could show that chronic pain patients (exempt patients with chronic headache) showed a highly significant better improvement in terms of ADS after MPTP when participating in autumn (coefficient: −11.67, p = .004). Patients treated during winter showed a tendency towards a better improvement in ADS scores (coefficient: −6.89, p = .051). These effects were not found in patients suffering from chronic headache. Finally, patients participating in MPTPs during summer, autumn, and winter presented a tendency of higher reduction in pain scores when compared to patients participating in spring. In conclusion, the effect of MPTPs in terms of psychological stabilization is considered to be best during autumn. This should be therefore considered in planning an MPTP in all patients who do not need immediate psychological stabilization. The treatment effect of MPTP on pain seems not being dependent on a specific season.

Katastrofizacija, anksioznost i depresivnost kod pacijenata s kroničnom nemalignom boli

The aim of this study was to determine the level of anxiety and depression and the intensity of pain in patients with chronic non-malignant pain, the correlation of catastrophizing with these factors, and the interaction of a multidisciplinary program for the treatment of chronic pain and the level of catastrophizing, anxiety, depression and pain intensity. The study was conducted on a sample of 44 participants aged 32 to 80 years who participated in the multidisciplinary program for chronic pain management at the Institute for Pain Management of the Clinical Medical Center Osijek. Pain intensity was measured using the Visual Analog Scale (VAS); the Depression, Anxiety and Stress Scale (DASS-21) was used to measure anxiety and depression; while catastrophizing was measured using the Pain Catastrophizing Scale (PCS). There was a moderate positive correlation between anxiety, depression, and pain intensity in patients with chronic non-malignant pain; a positive correlation between anxiety, depression, pain intensity, and catastrophic factors; and a reduction of anxiety, depression, pain intensity and catastrophization at the end of a multidisciplinary chronic pain treatment program. The findings contribute to a better understanding of the relation between emotional distress, cognitions and pain intensity in patients with chronic non-malignant pain.

Use of bisphosphonates in a retrospective case series of children and adolescents with complex regional pain syndrome.

There is increasing evidence for the use of bisphosphonates to treat Complex Regional Pain Syndrome in adults. However, there are scarce data for their use in children with Complex Regional Pain Syndrome. This retrospective case series aimed to analyze the effects of intravenous bisphosphonate use in children and adolescents with Complex Regional Pain Syndrome enrolled in a multidimensional pain treatment program. We analyzed the data of 16 patients (15 females and 1 male, mean age 14±3years) who received infusions of zoledronic acid (0.015±0.0044mg/kg), pamidronate (0.72±0.17mg/kg), or both depending on their initial response between October 2014 and December 2019. The primary endpoint of the study was the patient's global impression of change. Secondary outcomes included pain intensity, physical function, role function (school attendance), need for pain medications, and adverse effects. Nine of 16 patients reported meaningful improvements (global impressions of change of 84% or higher) at a median follow-up time of 16 (8-21) months after their last infusion of bisphosphonates. There were also meaningful reductions in pain intensity and the need for pain medications. There was an increase in the proportion of patients with minimal or without physical disability, and almost all patients normalized their school activities. Thirteen patients (81%) reported adverse effects, mostly flu-like symptoms, for a few days after the infusion. The use of bisphosphonate infusions may represent an effective treatment option for children with Complex Regional Pain Syndrome, not responding to multidisciplinary pain treatment programs.

Comparative Effectiveness of Embedded Mental Health Services in Pain Management Clinics vs Standard Care.

Embedded behavioral medicine services are a common component of multidisciplinary chronic pain treatment programs. However, few studies have studied whether these services are associated with improved treatment outcomes. Using a retrospective, matched, two-cohort study design, we examined patient-reported outcomes (PROs), including Patient-Reported Outcomes Measurement Information System pain, mental health, and physical function measures, collected at every clinic visit in every patient. Changes from baseline through 12 months were compared in those receiving embedded Behavioral Medicine in addition to usual care to a Standard Care group seen in the same pain practice and weighted via propensity scoring. At baseline, Behavioral Medicine patients had worse scores on most pain, mental health, and physical health measures and were more likely to be female, a member of a racial minority, and have lower socioeconomic status. Regardless of having a worse clinical pain syndrome at baseline, at follow-up both Behavioral Medicine (N = 451) and Standard Care patients (N = 8,383) showed significant and comparable improvements in pain intensity, physical function, depression, and sleep disturbance. Behavioral Medicine patients showed significantly greater improvements in their global impressions of change than the Standard Care patients. Despite worse pain and physical and psychological functioning at baseline, Behavioral Medicine patients showed improvements comparable to patients not receiving these services. Further, Behavioral Medicine patients report higher global impressions of change, indicating that embedded mental health services appear to have the additive value of amplifying the benefits of multimodal pain care.

App-based multidisciplinary back pain treatment versus combined physiotherapy plus online education: a randomized controlled trial

Non-specific low back pain (LBP) is one of the leading causes of global disability. Multidisciplinary pain treatment (MPT) programs comprising educational, physical, and psychological interventions have shown positive treatment effects on LBP. Nonetheless, such programs are costly and treatment opportunities are often limited to specialized medical centers. mHealth and other digital interventions may be a promising method to successfully support patient self-management in LBP. To address these issues, we investigated the clinical effects of a multidisciplinary mHealth back pain App (Kaia App) in a randomized controlled trial (registered at German Clinical Trials Register under DRKS00016329). One-hundred one adult patients with non-specific LBP from 6 weeks to 1 year were randomly assigned to an intervention group or a control group. In the intervention group, the Kaia App was provided for 3 months. Control treatment consisted of six individual physiotherapy sessions over 6 weeks and high-quality online education. The primary outcome, pain intensity, was assessed at 12-week follow-up on an 11-point numeric rating scale (NRS). Our per-protocol analysis showed no significant differences between the groups at baseline (Kaia App group: M = 5.10 (SD = 1.07) vs. control group: M = 5.41 (SD = 1.15). At 12-week follow-up the Kaia App group reported significantly lower pain intensity (M = 2.70 (SD = 1.51)) compared to the control group (M = 3.40 (SD = 1.63)). Our results indicate that the Kaia App as a multidisciplinary back pain app is an effective treatment in LBP patients and is superior to physiotherapy in combination with online education.

Interventional procedures in children and adolescents with chronic non-cancer pain as part of a multidisciplinary pain treatment program.

Interventional procedures are part of multidisciplinary pain treatment programs to treat chronic non-cancer pain conditions in children and adolescents. However, the real benefit of these interventions remains unclear. The aim of this study was to analyze the potential benefits of the interventional procedures in children and adolescents with chronic non-cancer pain in the setting of a multidisciplinary pain treatment program. We retrospectively reviewed the charts of 98 children and adolescents receiving 314 diagnostic or therapeutic interventional procedures. We applied the following definitions of efficacy Short-term positive therapeutic effect: block that produced a minimum of 50% reduction in pain intensity for at least 4weeks. Long-term positive therapeutic effect: a patient with a minimum of 50% reduction in pain intensity for at least 6months Full recovery: a patient free of pain, not taking analgesics with normal physical and role functioning 6months after the last procedure. Seventy-six of 112 diagnostic blocks (68%) were associated with a 50% reduction in pain intensity for at least 4weeks after the procedure. One hundred and sixty-six of 202 therapeutics blocks (82%) were associated with a short-term benefit. Seventy-two of 98 patients (73%) referred a 50% reduction in their pain intensity (17%) or had full recovery 6months after the procedures (56%) and a MPTP. Psychiatric comorbidity and more advanced age were factors associated with failure to respond to interventional procedures. The use of interventional procedures may represent a valid therapeutic option, associated with positive clinical outcomes within a multidisciplinary program.

OP92 Non-Opioid Therapy For Pain Management – Health Technology Assessment In A Time Of Crisis

Introduction:North America is facing a public health epidemic – the opioid crisis – part of which is attributed to the inappropriate use of opioids in pain management. As such, the 2017 Canadian Guideline for Opioids for Chronic Non-Cancer Pain recommends optimizing non-opioid pharmacotherapy or non-pharmacological therapy to treat chronic pain, before a trial of opioids. However, the Guideline itself is not designed to provide evidence on the effectiveness of these non-opioid alternatives, leaving a gap for those attempting to put the recommendation into practice.Methods:In collaboration with its partners, including clinicians and policymakers, the Canadian Agency for Drugs and Technologies (CADTH) identified the gaps in evidence, and developed an action plan to bridge the evidence gaps to support the optimization of non-opioid alternatives in pain management.Results:Since the release of the Guideline, CADTH produced over 20 Rapid Response reports that synthesize and appraise evidence on non-opioid alternatives in the management of a wide range of pain, both acute and chronic. Additionally, CADTH has also reviewed evidence on multidisciplinary pain treatment programs, and is developing environmental scan reports on the availability and access to non-pharmacological treatments for pain in Canada, and on drugs for emerging non-opioid pain. Further, CADTH developed knowledge mobilization tools based on the evidence reviews. The evidence reviews and tools are used as a resource by CADTH partners, including the Coalition of Safe and Effective Pain Management and McMaster University National Pain Center.Conclusions:This presentation will discuss the role of HTA and CADTH to fill the gaps in evidence for a crucial clinical practice guideline recommendation in a time of public health crisis, and help put the evidence into action. It will present the evidence synthesized by CADTH on various non-opioid alternatives for pain management, while highlighting the remaining gaps in evidence. Understanding the evidence on non-opioid alternatives will inform clinical and policy decisions and potentially reduce inappropriate use of opioids in pain management.

Expression of miRNA-124a in CD4 Cells Reflects Response to a Multidisciplinary Treatment Program in Patients With Chronic Low Back Pain.

A prospective evaluation of microRNA (miRNA) expression in patients with chronic low back pain (CLBP). The aim of this study was to evaluate whether pain- and T cell-related miRNAs are differentially expressed in CLBP when compared with healthy volunteers and whether these miRNAs may distinguish between responders and nonresponders to a multidisciplinary treatment program. CLBP is a common health problem worldwide. Multidisciplinary pain treatment programs have been proven as an effective treatment option. miRNAs are known to be important mediators of gene regulation in various processes, including pathophysiology of pain. The expression of miRNAs in CLBP and changes due to a multidisciplinary treatment programs are still unknown. Thirty-four patients with CLBP were enrolled (46.5 ± 12.7 yrs). CLBP was defined as low back pain with an average intensity of numerical rating scale (NRS) ≥3 during the last 4 weeks, persisting longer than 6 months, and not attributable to a recognized specific pathological condition. Expression of pain- and T cell-related miRNAs in human CD4 cells were determined using TaqMan assays and RealTime PCR. MiRNA expression in patients with CLBP was compared with the expression in healthy volunteers before a multidisciplinary treatment program started. The multidisciplinary outpatient program (4 weeks, 5 days a week, 8 h per day) is a clinically established outpatient program and comprises medical (examination, education), physical (exercise), work-related, and psychological therapy components. After the program, differentially expressed miRNAs in CLBP (before treatment) were analyzed once more. Expression of these miRNAs in patients who respond to the treatment (n = 14) was compared with those who did not respond (n = 20). Response to therapy was defined as reduction of pain of ≥50% (NRS) from baseline. MiRNA-124a (patients: 0.79 ± 0.63 vs. healthy volunteers: 0.30 ± 0.16; P < 0.001), miRNA-150 (patients: 0.75 ± 0.21 vs. healthy volunteers: 0.56 ± 0.20; P = 0.025), and miRNA-155 (patients: 0.55 ± 0.14 vs. healthy volunteers: 0.38 ± 0.16; P = 0.017) were significantly upregulated in CLBP patients when compared with healthy volunteers. After the multidisciplinary treatment program, patients who respond to the treatment showed only an increase of miRNA-124a expression (before treatment: 0.54 ± 0.26 vs. after treatment: 1.05 ± 0.56, P = 0.007). MiRNA-124a upregulation is associated with therapy response in a multidisciplinary treatment programs and might help to identify more specific and mechanism-based treatment strategies for CLBP. 3.

Multimodal pain therapy. Current situation

A multidisciplinary approach for the management of patients with chronic pain is now well-established in many countries, especially in situations involving a complex disease process in the sense of a biopsychosocial model. Both the efficacy and cost-effectiveness of multidisciplinary pain treatment programs and their superiority compared to unimodal therapy has been documented in a number of studies, reviews and meta-analyses, in particular for patients suffering from chronic low back pain. Nevertheless, there are still major shortcomings concerning the definition of multimodal and multidisciplinary treatment and the quality of structures and processes, compared for example to the standards defined by the German Pain Society (Deutsche Schmerzgesellschaft). Furthermore, there is still no consensus on specific therapeutic approaches, the differentiation between responders and non-responders as well as on the tools required for measurement. All these questions will have to be answered by concerted efforts in a multicenter setting.

MBMD Coping Styles and Psychiatric Indicators and Response to a Multidisciplinary Pain Treatment Program

Psychosocial and personality factors are known to contribute to the maintenance of and recovery from chronic pain conditions but less is known about their influence on the efficacy of pain treatment programs. The purpose of the present study is to examine the ability of the Millon Behavioral Medicine Diagnostic (MBMD), a broadband measure of personality and psychosocial characteristics, to predict response to multidisciplinary pain treatment. 93 patients completed the MBMD, and ratings of current pain and average pain on an 11 point scale, prior to a multidisciplinary pain management program. Ratings of current and average pain were completed upon program completion. Participants were classified as "successful" or "unsuccessful" program completers based on pain reductions of ≥2 points. After program completion, 47 % of participants evidenced successful pain reductions. These successful participants had lower scores on depression and on coping style scales measuring introversive, inhibited, and dejected tendencies at baseline. Additionally, lower pre-treatment depression scores and lower scores on each of these coping style scales predicted lower pain ratings at discharge independent of educational level and pre-treatment pain ratings. The MBMD may be a useful tool to delineate patients who are likely to make significant treatment gains in intense, multidisciplinary pain treatment programs.

Bedeutung des Bildungsniveaus für die Wirksamkeit der multimodalen Schmerztherapie

The recommended treatment for chronic pain is multidisciplinary with a cognitive approach. The aim of this study was to investigate whether the education level of patients was predictive of main outcome dimensions (pain intensity, disability, depression, physical functioning and return to work). This was a secondary analysis of 413 patients who participated in an in-patient multidisciplinary pain treatment program. All patients were studied at baseline and after 6 months. The aim was to find predictors for the changes in scores of outcome measures (from admission to follow-up). Possible predictors were educational level and other available variables that are considered prognostic of treatment outcome, including age, gender, body mass index, endurance of pain, pain intensity, depressive symptoms and work status. Classification trees were used to predict outcome variables. The outcome was markedly improved in the sampling collective at follow-up compared with baseline. Education was the best predictor of treatment outcome and affected 4 out of the 5 outcome dimensions analyzed. If education level proves to be an intervening variable in further research, education adjusted treatment programs should be developed and evaluated.

Adaptive Versus Maladaptive Coping and Beliefs and Their Relation to Chronic Pain Adjustment

Coping and beliefs are cornerstones to our understanding of adjustment to chronic pain. This study sought to test the hypothesis that maladaptive pain-related coping and beliefs are more strongly related to measures of patient adjustment than are adaptive coping and beliefs. A sample of 106 veterans with mixed chronic pain diagnoses in a multidisciplinary pain treatment program were administered measures of pain beliefs and pain coping, and composite scores were computed to reflect adaptive and maladaptive responses. Correlations between the composite scores and outcomes (pain intensity, pain interference, depression) were examined. Hierarchical multiple regressions were also conducted to estimate the independent contributions of adaptive and maladaptive responses. The maladaptive response composite score was found to be significantly related to pain interference and depression, whereas both adaptive and maladaptive response composite scores were found to be significantly related to pain intensity. The maladaptive response composite showed stronger independent associations with pain interference and depression after controlling for demographic variables, pain intensity, and adaptive responses. Contrary to expectations, only the adaptive response composite showed an independent association with pain intensity. The findings suggest that the relative importance of adaptive versus maladaptive beliefs and coping may differ as a function of the outcome domain in question. The findings support current cognitive-behavioral interventions that focus on reducing the frequency of maladaptive coping responses and beliefs as a way to improve patient functioning.

Ethnic Group Differences in the Outcomes of Multidisciplinary Pain Treatment

OBJECTIVES: The aim of this prospective investigation was to evaluate ethnic group differences in pain-related outcomes following multidisciplinary chronic pain treatment. A prospective pre- and post-treatment assessment design was employed to investigate the effects of ethnicity on changes in pain-related variables following completion of a multidisciplinary pain treatment program. METHODS: One hundred fifty five chronic pain patients participating in a multidisciplinary pain treatment program completed measures of pain and mood both prior to and following the four-week treatment. Primary outcome variables included pain severity, pain-related interference, and depressive symptoms. RESULTS: Baseline differences between African-Americans and Whites were observed for depressive symptoms, but not for pain severity or pain-related interference. Following multidisciplinary pain treatment, both White and African-American patients displayed post-treatment reductions in depressive symptoms and pain-related interference. However, White patients also reported reduced pain severity while African-Americans did not. CONCLUSIONS: The treatment approach used in the present study appeared to be less effective in reducing self-reported pain severity in African-American versus White patients, though both groups benefited in terms of reduced depressive symptoms and pain-related interference. Moreover, the observation that improvements in functioning occurred without reductions in pain severity in African-American patients suggests that differences may exist in treatment processes as a function of ethnic group, and will consequently be an important area for future research.

A 50-Year-Old Man With Chronic Low Back Pain

Mr S, a 50-year-old man, has long-standing low back pain. His pain began more than 20 years earlier with a lumbar disk herniation and has persisted despite diskectomy. He has undergone numerous treatments, but he remains disabled with ongoing pain. His treatment course is used to frame the epidemiology and pathophysiology underlying acute and chronic lumbosacral and radicular pain. The roles of neuropathic pain medications, chronic opioid therapy, physical therapy, spinal manipulation, and multidisciplinary pain treatment programs are reviewed. The indications for and outcomes associated with interventional pain treatments, including epidural steroid injection, facet blocks and radiofrequency treatment for facet-related pain, intradiskal electrothermal therapy, spinal cord stimulation, and intrathecal drug delivery, are discussed. Clinicians are given an evidence-based approach to using available treatment options for low back pain.

Complementary and alternative medicine approaches to pain management

This article argues for and illustrates incorporating complementary and alternative medicine (CAM) interventions into pain treatment plans. Two CAM treatments, cranial electrotherapy stimulation (CES) and self-hypnosis training, are offered in a multidisciplinary pain treatment program. Because these interventions focus on pain relief, they may be of particular interest to patients who have chronic pain who begin treatment with a primary interest in pain reduction. Two cases that illustrate the clinical application of CES and self-hypnosis are presented. When effective, these interventions can help patients have greater confidence in treatments offered by psychologists for pain management and may help make them more open to participating in other psychological interventions that have established efficacy for pain management (e.g., cognitive-behavioral therapy). Because of their brevity, these treatments also can be offered alone to patients who may not have the resources or time to participate in more time-intensive treatment.

(871): Web-based treatment follow-up for multidisciplinary pain management programs: Patient usage and short-term treatment outcome of the Arthritis Institute Internet Clinic

Multidisciplinary chronic pain treatment programs teach patients to incorporate symptom-management strategies into their daily routine, including exercise, activity pacing, relaxation and cognitive-behavioural strategies for stress and emotional distress. Such programs demonstrate decreases in pain, disability levels, health care utilization, and improved psychosocial functioning. However, many patients are unable to maintain these lifestyle changes long-term. This study will determine if web-based treatment follow-up services improve patients’ short-term maintenance of disease management strategies, symptom severity and functional limitations. The Arthritis Institute Internet Clinic (AIIC) provides cost-effective follow-up treatment through interactive, on-line problem-solving / relapse prevention workshops, FAQ pages, and discussion boards. Patients (N= 245) with inflammatory arthritis, osteoarthritis and fibromyalgia were randomly assigned to: 1) treatment (post-treatment access to AIIC) (N= 118) or 2) a standard care control group (N= 127). Usage data revealed that 33.1% of patients accessed the AIIC. Usage varied by diagnosis; a greater percentage of fibromyalgia patients (45.6%) logged on than arthritis patients (21.3%), but arthritis patients had more “hits” per patient (X= 5.54, s.d. = 7.69 vs. X= 2.27, s.d. = 1.25; p< .039). Users rated the AIIC as “helpful”, and 70.4% of users indicated that they found the information / assistance needed. A mixed model (treatment vs. control) MANOVA evaluated the impact of AIIC access on outcome variables (pain severity, fatigue, functional limitations, mood, coping strategy use, health care utilization) at admission, discharge, and one month post-treatment. Treatment and control group outcome measures were equivalent at admit, discharge and one month follow-up, suggesting that access to the AIIC did not provide short-term benefit. Additional analyses investigate variables predicting AIIC use, and compare the treatment outcome of AIIC ‘users” vs. “non-users” and controls. To conclude, this project provides detailed information regarding the appeal, utility and short-term efficacy of web-based treatment follow-up services. Multidisciplinary chronic pain treatment programs teach patients to incorporate symptom-management strategies into their daily routine, including exercise, activity pacing, relaxation and cognitive-behavioural strategies for stress and emotional distress. Such programs demonstrate decreases in pain, disability levels, health care utilization, and improved psychosocial functioning. However, many patients are unable to maintain these lifestyle changes long-term. This study will determine if web-based treatment follow-up services improve patients’ short-term maintenance of disease management strategies, symptom severity and functional limitations. The Arthritis Institute Internet Clinic (AIIC) provides cost-effective follow-up treatment through interactive, on-line problem-solving / relapse prevention workshops, FAQ pages, and discussion boards. Patients (N= 245) with inflammatory arthritis, osteoarthritis and fibromyalgia were randomly assigned to: 1) treatment (post-treatment access to AIIC) (N= 118) or 2) a standard care control group (N= 127). Usage data revealed that 33.1% of patients accessed the AIIC. Usage varied by diagnosis; a greater percentage of fibromyalgia patients (45.6%) logged on than arthritis patients (21.3%), but arthritis patients had more “hits” per patient (X= 5.54, s.d. = 7.69 vs. X= 2.27, s.d. = 1.25; p< .039). Users rated the AIIC as “helpful”, and 70.4% of users indicated that they found the information / assistance needed. A mixed model (treatment vs. control) MANOVA evaluated the impact of AIIC access on outcome variables (pain severity, fatigue, functional limitations, mood, coping strategy use, health care utilization) at admission, discharge, and one month post-treatment. Treatment and control group outcome measures were equivalent at admit, discharge and one month follow-up, suggesting that access to the AIIC did not provide short-term benefit. Additional analyses investigate variables predicting AIIC use, and compare the treatment outcome of AIIC ‘users” vs. “non-users” and controls. To conclude, this project provides detailed information regarding the appeal, utility and short-term efficacy of web-based treatment follow-up services.

Cognitive/behavioral approaches: Providing web-based treatment follow-up services for chronic pain management programs: Ethical concerns, professional issues and design considerations

Multidisciplinary chronic pain treatment programs teach patients to incorporate symptom-management strategies into their daily routine, including exercise, activity pacing, proper body mechanics, relaxation and cognitive-behavioural strategies for stress and emotional distress. Such programs have been shown to result in decreased pain, disability levels and health care utilization, and improved psychosocial functioning. However, many patients are unable to maintain these significant lifestyle changes long-term. Patients attending our multidisciplinary Rheumatology Day Programs have identified a need for treatment follow-up to facilitate long-term maintenance, but these services are limited due to current staffing constraints. The Arthritis Institute Internet Clinic (AIIC) was proposed as a means to offer novel, cost-effective follow-up treatment through both education and interactive, on-line problem-solving / relapse prevention workshops. This presentation will provide an in-depth examination of the ethical and professional issues involved in providing web-based treatment services. Existing guidelines for web-based health care and research will be reviewed, addressing issues such as the informed consent process, participant privacy and confidentiality, clinician – client communication, and professional accountability. Challenges faced during the program development phase of the AIIC will highlight the fact that development of comprehensive ethical and professional guidelines for web-based treatment and research has not kept pace with rapid advances in the field of e-health. Specific guidelines and practical solutions will be provided for a number of ethical concerns and professional dilemmas faced in the development of the Arthritis Institute Internet Clinic. Future research will examine patients' willingness to use web-based follow-up treatment services, and will determine if web-based treatment follow-up services will result in improved disease management and decreased health care utilization.

Long-term outcomes in multidisciplinary treatment of chronic low back pain: results of a 13-year follow-up.

Patients completing a multidisciplinary pain treatment were contacted to obtain 13-year follow-up information on pain, mood, employment, and general health. Study objectives were to determine if post-treatment improvements were maintained over a lengthy follow-up period and to compare patients' general health to norms of comparably aged persons. Although many studies have demonstrated the short-term effectiveness of multidisciplinary pain treatment programs for chronic low back pain, few studies have documented that these treatment gains are maintained over time. Only two studies have reported patient outcomes on a long-term basis (10+ years). Those studies have documented that patient gains during treatment are generally maintained during follow-up. An attempt was made to contact all patients completing an inpatient chronic back pain rehabilitation program at the University of Iowa's Spine Diagnostic and Treatment Center. Of the 45 participants, 28 were located and 26 agreed to participate in a telephone interview. Analyses of pretreatment and posttreatment data revealed these follow-up participants did not differ from the larger study sample. Patients maintained their treatment gains in all areas (pain intensity and interference, negative mood). Additionally, patients showed levels of general health comparable to similarly aged peers with the exceptions of pain (more pain) and physical functioning (lower functioning, more pain interference). More than half the sample was employed; of those not employed, few reported this was due to pain. The data lend support to the long-term effectiveness of multidisciplinary treatment programs for chronic low back pain.