A Descriptive Longitudinal Study of Chronic Pain Outcomes and Gender Differences in a Multidisciplinary Pain Management Centre

Teik G. Tay, Andrea L. Willcocks, Judy F. Chen, Grazyna Jastrzab, Kok E. Khor

Department Pain Management, Level 1 McNevin-Dickson Building, Prince of Wales Hospital, Randwick, NSW Australia.

DOI: 10.4236/pst.2014.22010                

Abstract

Background: The long-term outcomes of patients with chronic pain treated in a multidisciplinary pain management center remain variable. Objective: This study aims to evaluate the changes in outcomes of patient’s self-reported pain, psychosocial status, health related quality of life and gender differences following treatment in amultidisciplinary pain management centre. Design: A prospective longitudinal cross-sectional study uses questionnaires. Treatment Setting: A pragmatic and individualized patient centered approach in a tertiary level multidisciplinary pain management center. Subjects: Patients with chronic pain referred to the centre from 2004-2010. Outcome Measures: Pain Numerical Rating Scale (NRS), Pain Temporal Description (1 - 6), Pain Self- Efficacy Questionnaire (PSEQ), Depression Anxiety Stress Scales (DASS-21) and Short Form-36 (SF- 36). Follow-up questionnaires were sent at 6 and 12 months after initial assessment. Results: Mean duration of baseline chronic pain was 8.1 years and 61% of chronic pains were involving the musculoskeletal system. At 6 and 12 month follow-ups, 273 and 180 participants had been surveyed respectively. At 6-month follow-up, there were significant improvements on pain intensity (Cohen’s d = 0.8), pain self-efficacy (Cohen’s d = 0.47), depression and stress scores (Cohen’s d = 0.16) and six out of eight domains of SF-36 (Cohen’s d = 0.2 - 0.4). At 12-month follow-up, improvements were maintained on pain intensity, self-efficacy and three out of eight domains of SF-36. There were distinctive pre- and post-treatment gender differences in these outcomes and overall females showed better short- and long-term outcomes than males. Conclusion: Multidisciplinary pain management using an individualized patient centered approach remains an effective treatment for chronic pain in both the short- (6 month) and long-term (12 month). The distinctive pre- and post-treatment gender differences particularly in the psychological outcomes, suggest that it may be beneficial to further delineate and better manage vulnerable patient subgroups.

Keywords

Multidisciplinary, Pain Management Center, Quality of Life, Chronic Pain, Self-Efficacy, Gender, Long-Term Outcome

Conflicts of Interest

The authors declare no conflicts of interest.

References

[1]	Blyth, F.M., March, L.M., Brnabic, A.J.M., Jorm, L.R., Williamson, M. and Cousins, M.J. (2001) Chronic Pain in Au- stralia: A Prevalence Study. Pain, 89, 127-134. http://dx.doi.org/10.1016/S0304-3959(00)00355-9
[2]	Blyth, F.M., March, L.M. and Cousins, M.J. (2003) Chronic Pain-Related Disability and Use of Analgesia and Health Services in a Sydney Community. Medical Journal of Australia, 179, 84-87.
[3]	Blyth, F.M., March, L.M., Nicholas, M.K. and Cousins, M.J. (2003) Chronic Pain, Work Performance and Litigation. Pain, 103, 41-47. http://dx.doi.org/10.1016/S0304-3959(02)00380-9
[4]	Kerr, S., Fairbrother, G. and Crawford, M. (2004) Patient Characteristics and Quality of Life among a Sample of Australian Chronic Pain Clinic Attendee. Internal Medical Journal, 34, 403-409. http://dx.doi.org/10.1111/j.1444-0903.2004.00627.x
[5]	Jensen, M.P., Turner, J.A. and Romano, J.M. (2007) Changes after Multidisciplinary Pain Treatment in Patient Pain Beliefs and Coping Are Associated with Concurrent Changes in Patient Functioning. Pain, 131, 38-47. http://dx.doi.org/10.1016/j.pain.2006.12.007
[6]	McCracken, L.M. and Zhao-Obrien, J. (2010) General Psychological Acceptance and Chronic Pain: There Is More to Accept than the Pain Itself. European Journal of Pain, 14, 170-175. http://dx.doi.org/10.1016/j.ejpain.2009.03.004
[7]	Jensen, M.P., Nielson, W.R., Turner, J.A., Romano, J.M. and Hill, M.L. (2004) Changes in Readiness to Self-Manage Pain Are Associated with Improvement in Multidisciplinary Pain Treatment and Pain Coping. Pain, 111, 84-95. http://dx.doi.org/10.1016/j.pain.2004.06.003
[8]	Flor, F., Fydrich, T. and Turk, D.C. (1992) Efficacy of Multidisciplinary Pain Treatment Centers: A Meta-Analytic Re- view. Pain, 49, 221-230. http://dx.doi.org/10.1016/0304-3959(92)90145-2
[9]	Guzman, J., Esmail, R., Karjalainen, K., Malmivaara, A., Irvin, E. and Bombardier, C. (2001) Multidisciplinary Reha- bilitation for Chronic Low Back Pain: Systematic Review. BMJ, 322, 1511-1516. http://dx.doi.org/10.1136/bmj.322.7301.1511
[10]	Artner, J., Kurx, S., Cakir, B., Reichel, H. and Lattig, F. (2012) Intensive Interdisciplinary Outpatient Pain Management Program for Chronic Back Pain: A Pilot Study. Journal of Pain Research, 5, 209-216. http://dx.doi.org/10.2147/JPR.S31754
[11]	Becker, N., Sjogren, P., Bech, P., Olsen, A.F. and Eriksen, J. (2000) Treatment Outcome of Chronic Non-Malignant Pain Patients Managed in a Danish Multidisciplinary Pain Center Compared to General Practice: A Randomized Controlled Trial. Pain, 84, 203-211. http://dx.doi.org/10.1016/S0304-3959(99)00209-2
[12]	Turk, D.C., Wilson, H.D. and Cahana, A. (2011) Treatment of Chronic Non-Cancer Pain. Lancet, 377, 2226-2235. http://dx.doi.org/10.1016/S0140-6736(11)60402-9
[13]	McQuay, H.J., Eccleson, C., Morley, S. and de C Williams, A.C. (1997) Systematic Review of Outpatient Services for Chronic Pain Control. Health Technology Assessment, 1, 6.
[14]	Dysvik, E., Kvaloy, J.T. and Natvig, G.K. (2012) The Effectiveness of an Improved Multidisciplinary Pain Management Programme: A 6- and 12-Month Follow-Up Study. Journal of Advanced Nursing, 68, 1061-1072. http://dx.doi.org/10.1111/j.1365-2648.2011.05810.x
[15]	Baranoff, J., Hanrahan, S.J., Kapur, D. and Connor, J.P. (2013) Six Month Post-Treatment Deterioration in Acceptance (CPAQ-8) and Cognitions Following Multidisciplinary Pain Treatment. Journal of Behavior Medicine, Ahead of Print.
[16]	de Rooij, A., van der Leeden, M. and Roorda, L.D. (2013) Predictors of Outcome of Multidisciplinary Treatment in Chronic Widespread Pain: An Observational Study. BMC Musculoskelet Disorder, 14, 133-144. http://dx.doi.org/10.1186/1471-2474-14-133
[17]	Keogh, E., McCracken, L.M. and Eccleston, C. (2005) Do Men and Women Differ in Their Response to Interdisciplinary Chronic Pain Management. Pain, 114, 37-46. http://dx.doi.org/10.1016/j.pain.2004.12.009
[18]	Skouen, J.S., Grasdal, A. and Haldorsen E.M.H. (2006) Return to Work after Comparing Outpatient Multidisciplinary Treatment Program versus Treatment in General Practice for Patients with Chronic Widespread Pain. European Journal of Pain, 10, 145-152. http://dx.doi.org/10.1016/j.ejpain.2005.02.005
[19]	Hooten, W.M., Townsend, C.O. and Decker, P.A. (2007) Gender Differences among Patients with Fibromyalgia Undergoing Multidisciplinary Pain Rehabilitation. Pain Medicine, 8, 624-632. http://dx.doi.org/10.1111/j.1526-4637.2006.00202.x
[20]	Bandura, A. (1977) Self-Efficacy: Toward a Unifying Theory of Behavioural Change. Psychological Review, 84, 191- 215. http://dx.doi.org/10.1037/0033-295X.84.2.191
[21]	Nicholas, M.K. (1989) Self-Efficacy and Chronic Pain. Annual Conference of the British Psychological Society, St. Andrews.
[22]	Nicholas, M.K. (2007) The Pain Self-Efficacy Questionnaires: Taking Pain into Account. European Journal of Pain, 11, 153-163. http://dx.doi.org/10.1016/j.ejpain.2005.12.008
[23]	Keefe, F.J., Lefebvre, J.C., Maxiner, W., Salley, A.N. and Caldwell, D.S. (1997) Self-Efficacy for Arthritis Pain: Relationship to Perception of Thermal Laboratory Pain Stimuli. Arthritis & Rheumatism, 10, 177-184. http://dx.doi.org/10.1002/art.1790100305
[24]	Parkitny, L., McAuley, J.H., Walton, D., Pena Costa, L.O., Refshauge, K.M., Wand, B.M., Di Pestro, F. and Moseley, G.L. (2012) Rasch Analysis Supports the Use of the Depression, Anxiety, and Stress Scales to Measure Mood in Groups but Not in Individuals with Chronic Low Back Pain. Journal of Clinical Epidemiology, 65, 189-198. http://dx.doi.org/10.1016/j.jclinepi.2011.05.010
[25]	Wood, B.M., Nicholas, M.K., Blyth, F., Asghari, A. and Gibson, S. (2010) The Utility of the Short Version of the Depression Anxiety Stress Scales (DASS-21) in Elderly Patients with Persistent Pain: Does Age Make a Difference? Pain Medicine, 11, 1780-1790. http://dx.doi.org/10.1111/j.1526-4637.2010.01005.x
[26]	Shea, T.L., Tennant, A. and Pallant, J.F. (2009) Rasch Model Analysis of the Depression, Anxiety and Stress Scales (DASS). BMC Psychiatry, 9, 21. http://dx.doi.org/10.1186/1471-244X-9-21
[27]	Okifuji, A., Turk, D.C. and Kalauoklani, D. (1999) Clinical Outcome and Economic Evaluation of Multidisciplinary Pain Centers. In: Block, A.R., Kramer, E.F. and Fernandez, E., Eds., Handbook of Pain Syndromes: Biopsychosocial Perspectives, Lawrence Erlbaum Associates, Mahwah, 77-97.
[28]	Cohen, J. (1983) Statistical Power Analysis for the Behavioural Sciences. 2nd Edition, Lawrence Erlbaum Associates, Hillsdale.
[29]	Cnaan, A., Laird, N.M. and Slasor, P. (1997) Using the General Linear Mixed Model to Analyse Unbalanced Repeated Measures and Longitudinal Data. Statistics in Medicine, 16, 2349-2380. http://dx.doi.org/10.1002/(SICI)1097-0258(19971030)16:20<2349::AID-SIM667>3.0.CO;2-E
[30]	Krueger, C. and Tian, L. (2004) A Comparison of the General Linear Mixed Model and Repeated Measures ANOVA Using a Dataset with Multiple Missing Data Points. Biological Research for Nursing, 6, 151-157. http://dx.doi.org/10.1177/1099800404267682
[31]	Arnow, B.A., Hunkeler, E.M., Blasey, C.M., Lee, J., Constantino, M.J., Firemen, B., Kraemer, H., Dea, R., Robinson, R. and Hayward, C. (2006) Comorbid Depression, Chronic Pain, and Disability in Primary Care. Psychosomatic Medicine, 68, 262-268. http://dx.doi.org/10.1097/01.psy.0000204851.15499.fc
[32]	Cheatle, M. (2011) Depression, Chronic Pain, and Suicide by Overdose: On the Edge. Pain Medicine, 12, S43-S48. http://dx.doi.org/10.1111/j.1526-4637.2011.01131.x
[33]	Hampel, P., Graef, T., Krohn-Grimberghe, B. and Tlach, L. (2009) Effects of Gender and Cognitive-Behavioral Management of Depressive Symptoms on Rehabilitation Outcome among Inpatient Orthopaedic Patients with Chronic Low Back Pain: A 1 Year Longitudinal Study. European Spine Journal, 18, 1867-1880. http://dx.doi.org/10.1007/s00586-009-1080-z
[34]	Jensen, I.B., Bergstrom, G., Ljungquist, T. and Bodin, L. (2005) A 3-Year Follow-Up of a Multidisciplinary Rehabilitation Programme for Back and Neck Pain. Pain, 115, 273-283. http://dx.doi.org/10.1007/s00586-009-1080-z.
[35]	Meredith, P., Strong, J. and Feeney, J.A. (2006) Adult Attachment, Anxiety and Pain Self-Efficacy as Predictors of Pain Intensity and Disability. Pain, 123, 1-2, 146-154.
[36]	Woby, S.R., Urmston, M. and Watson, P.J. (2007) Self-Efficacy Mediates the Relation between Pain-Related Fear and Outcome in Chronic Low Back Pain Patients. European Journal of Pain, 11, 71-78.
[37]	Fincham, J.E. (2008) Response Rate and Responsiveness for Surveys, Standards, and the Journal. American Journal of Pharmaceutical Education, 72, 43.
[38]	Flavell, H.A., Carrafa, G.P., Thomas, C.H. and Disler, P.B. (1996) Managing Chronic Back Pain: Impact If an Interdisciplinary Team Approach. Medical Journal of Australia, 165, 253-255.
[39]	Van Hoff, M.L., Van der Merwe, J.D., O’Dowd, J., Pavlov, P.W., Spruit, M., De Kleuver, M. and Van Limbeek, J. (2010) Daily Functioning and Self-Management in Patient with Chronic Low Back Pain after an Intensive Cognitive Behavioural Programme for Pain Management. European Spine Journal, 19, 1517-1526. http://dx.doi.org/10.1007/s00586-010-1435-5
[40]	Nicholas, M.K., Asghari, A., Blyth, F.M., et al. (2013) Self-Management Intervention for Chronic Pain in Older Adults: A Randomised Controlled trial. Pain, 154, 824-835. http://dx.doi.org/10.1016/j.pain.2013.02.009
[41]	Schatman, M.E. (2011) Psychological Assessment of Maldynic Pain: The Need for a Phenomenological Approach. In: Giordano, J., Ed., Maldynia: Inter-Disciplinary Perspective on the Illness of Chronic Pain, CRC Press, New York, 157-182.
[42]	Edwards, R.R., Doleys, D.M., Lowery, D. and Fillingim, R.B. (2003) Pain Tolerance as a Predictor of Outcome Following Multidisciplinary Treatment for Chronic Pain: Differential Effects as a Function of Sex. Pain, 106, 419-426. http://dx.doi.org/10.1016/j.pain.2003.09.004
[43]	Sheffield, D., Biles, P.L., Orom, H., Maixner, W. and Sheps, D.S. (2000) Race and Sex Differences in Cutaneous Pain Perception. Psychosomatic Medicine, 62, 517-523.
[44]	Edwards, R., Augustson E.M. and Fillingim, R. (2000) Sex Specific Effects of Pain Related Anxiety on Adjustment to Chronic Pain. Clinical Journal of Pain, 16, 46-53. http://dx.doi.org/10.1097/00002508-200003000-00008
[45]	Merry, B., Edwards, R.R., Buenaver, L.F., McGuire, L., Haythornthwaite, J.A., Doleys, D.M. and Campbell, C.M. (2011) Ethnic Group Differences in Outcomes of Multidisciplinary Pain Treatment. Journal of Musculoskeletal Pain, 19, 24-30. http://dx.doi.org/10.3109/10582452.2010.538821
[46]	Green, C.R., Anderson, K.O., Baker, T.A., Campbell, L.C., Decker, S., Fillingim R.B, Kaloukalani, D.A., Lasch, K.E., Myers, C., Tait, R.C., Todd, K.H. and Vallerand, A.H. (2003) The Unequal Burden of Pain: Confronting Racial and Ethnic Disparities in Pain. Pain Medicine, 4, 277-294. http://dx.doi.org/10.1046/j.1526-4637.2003.03034.x