A cost-utility analysis of multimodal pain rehabilitation in primary healthcare

Eklund, Katarina; Stålnacke, Britt-Marie; Stenberg, Gunilla; Enthoven, Paul; Gerdle, Björn; Sahlén, Klas-Göran

doi:10.1515/sjpain-2020-0050

Cited by 8 publications

(13 citation statements)

References 54 publications

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“…It has been shown to be more effective than care as usual for reducing pain and disability (9) and is considered to be costsaving in terms of, for example, decreasing lost work days and HCU (10,11). Though little studied, a few studies in primary care have reported similar results (12)(13)(14)(15)(16).…”

Section: Jrm-ccmentioning

confidence: 99%

Introduction of a Multimodal Pain Rehabilitation Intervention in Primary Care: A Pilot Study

Eklund

Stålnacke

Sundberg³

et al. 2023

JRM-CC

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Objective: To evaluate patient-reported outcome measures in patients with chronic musculoskeletal pain 1 year after participation in a case manager-led multimodal rehabilitation intervention in a Finnish primary care centre. Changes in healthcare utilization (HCU) were also explored.Methods: A prospective pilot study with 36 participants. The intervention consisted of screening, multidisciplinary team assessment, a rehabilitation plan and case manager follow-up. Data were collected through questionnaires filled in after the team assessment and 1 year later. HCU data 1 year before and 1 year after team assessment were compared.Results: At follow-up, satisfaction with vocational situation, self-reported work ability and health-related quality of life (HRQoL) had improved and pain intensity had diminished significantly for all participants. The participants who reduced their HCU improved their activity level and HRQoL. Early intervention by a psychologist and mental health nurse was distinctive for the participants who reduced HCU at follow-up.Conclusion: The findings demonstrate the importance of early biopsychosocial management of patients with chronic pain in primary care. Identification of psychological risk factors at an early stage may lead to better psychosocial wellbeing, improve coping strategy and reduce HCU. A case manager may free up other resources and thereby contribute to cost savings. LAY ABSTRACTThe majority of patients with chronic pain seek and receive care in primary care, yet their identification and management are often fragmented and inadequate. Many patients end up in a vicious circle of healthcare utilization (HCU), undergoing unnecessary diagnostic and medical procedures. Identifying those at risk of developing chronic pain and avoiding exclusion from work, family and social life may generate cost savings and reduce individual suffering. Multimodal rehabilitation (MMR) is an evidence-based treatment for patients with chronic pain, recurrently provided in specialized care but underutilized in primary care. This pilot study evaluated a case manager-led MMR intervention for patients with musculoskeletal chronic pain in a Finnish primary care centre. HCU was also studied. The results showed that addressing physiological, psychological and social factors in the patient’s life simultaneously and at an early stage may lead to reduced pain perception, increased psychosocial wellbeing and cost savings for society.

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Section: Jrm-ccmentioning

confidence: 99%

Introduction of a Multimodal Pain Rehabilitation Intervention in Primary Care: A Pilot Study

Eklund

Stålnacke

Sundberg³

et al. 2023

JRM-CC

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“…Eleven outcomes reflecting a BPS approach were evaluated 1 year after IPRP and 10 of these showed significant improvements although ESs were small (0.20-0.49) [92]. A cost-utility analysis indicated that IPRP in primary care was costeffective [93].…”

Section: The 22 Mandatory Outcome Variables In Sqrpmentioning

confidence: 99%

Perspective Chapter: Interdisciplinary Pain Rehabilitation Programs – Evidence and Clinical Real-World Results

Gerdle¹,

Fischer²,

Ringqvist³

2024

Pharmaceutical Science

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Chronic pain conditions are influenced by and interact with physical, psychological, social, and contextual factors. These conditions are associated with psychological distress, poor health, sick leave, and high socio-economic costs. Therefore, modern clinical practice applies a biopsychosocial (BPS) framework. Interdisciplinary pain rehabilitation programs (IPRPs) for chronic pain distinguish themselves as well-coordinated complex interventions. This chapter describes the contents of such programs. We will briefly review the evidence for IPRPs and discuss problems when evaluating these complex interventions. Furthermore, we will report practice-based results from a large Swedish pain registry—the Swedish Quality Registry for Pain Rehabilitation (SQRP). The SQRP collects data from a relevant special clinical department in Sweden—i.e., real-life outcomes will be depicted. Characteristics of patients that benefit the most from IPRPs will be described and discussed. The indications for IPRPs will also be presented. Finally, we will discuss how to improve rehabilitation for chronic pain patients.

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“…The data were collected from primary health care centers in the Norrbotten county of Sweden in 2011-2014 (Calner et al, 2017;Nordin et al, 2016). The studies by Pietilä-Holmner et al and Eklund et al were also both based on the same data; data from 11 primary health care centers in Sweden, collected in 2012-2015 (Eklund et al, 2020;Pietilä-Holmner et al, 2020). Two studies by Mårtensson et al were included, both of which were conducted using the same data, yet reporting different outcomes (Mårtensson et al, 1999;Mårtensson et al, 2004).…”

Section: Study Characteristicsmentioning

confidence: 99%

“…Two studies by Mårtensson et al were included, both of which were conducted using the same data, yet reporting different outcomes (Mårtensson et al, 1999;Mårtensson et al, 2004). Nine of the 17 studies included were conducted in Sweden (Calner et al, 2017;Eklund et al, 2020;Gustavsson et al, 2018;Mårtensson et al, 1999;Mårtensson et al, 2004;Nordin et al, 2016;Pietilä-Holmner et al, 2020;Sennehed et al, 2020;Stein & Miclescu, 2013), three in the United States (Dobscha et al, 2009;Seal et al, 2020), two in Canada (Angeles et al, 2013;Barry & Chris, 2019), one in Australia, one in England, and one in the Netherlands (Bults et al, 2023;Clare et al, 2019;Joypaul et al, 2019b; Table 1).…”

Section: Study Characteristicsmentioning

confidence: 99%

Multidisciplinary management of persistent pain in primary care—A systematic review

Huttunen,

Paananen,

Miettunen

et al. 2024

European Journal of Pain

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Background and ObjectiveA multidisciplinary approach is the gold standard in the management of persistent pain and is current practice in tertiary pain clinics. However, such approaches seem to be a rarity in primary care, although pain is the most common reason for visiting a primary care physician. A comprehensive systematic review was conducted to explore whether studies on multidisciplinary management programs for persistent pain exist in primary care.Databases and Data TreatmentPubMed, Ovid MEDLINE, Scopus, CINAHL, and PsychINFO were searched from inception to October 2022, and supplementary research was conducted in June 2023. Screening, data extraction, and quality assessment were independently carried out by two researchers. The inclusion criteria were (1) adult patients (age >18 years); (2) non‐cancer pain, persisting over 3 months; (3) multidisciplinary intervention (treatment included ≥3 heathcare professionals); (4) intervention conducted in a primary care setting; and (5) reports published in English.ResultsOf the 1250 initially identified studies, 17 were selected for final analysis. Only studies reporting empirical data were included (cohort, case–control, randomized controlled trial, and observational). The study settings and intervention characteristics showed great heterogeneity. The primary care practices also varied across different countries and cultures. Overall, the quality of the studies was rather low and sample sizes were relatively small.ConclusionsThe review revealed that studies about such treatment interventions for persistent pain patients are scarce. The existing studies were heterogeneous in terms of intervention characteristics, population, outcome variables, and study methodology. Future studies are urgently needed.SignificancePersistent pain is a growing challenge to the health care system, and most patients are treated in primary care. The biopsychosocial concept is the basis for the multidisciplinary management of pain. The review revealed that studies about treatment interventions for persistent pain patients are scarce. Existing studies were heterogeneous in terms of intervention characteristics, population, outcome variables, and study methodology. There is an urgent need for further studies on systematic multidisciplinary treatment protocols for managing persistent pain in primary care.

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A cost-utility analysis of multimodal pain rehabilitation in primary healthcare

Cited by 8 publications

References 54 publications

Introduction of a Multimodal Pain Rehabilitation Intervention in Primary Care: A Pilot Study

Introduction of a Multimodal Pain Rehabilitation Intervention in Primary Care: A Pilot Study

Perspective Chapter: Interdisciplinary Pain Rehabilitation Programs – Evidence and Clinical Real-World Results

Multidisciplinary management of persistent pain in primary care—A systematic review

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