A pilot study of the individual placement and support model for patients with chronic pain

Abstract

BackgroundIndividual Placement and Support (IPS) is an evidence-based work rehabilitation model with well-documented effects for people with mental illness. The model has, however, never been tested out for people with chronic pain. This pilot study aimed to investigate chronic pain patients’ experiences with the IPS job support model.MethodsWe recruited eight consecutive patients referred for various chronic pain conditions at a hospital outpatient pain clinic. They were offered IPS job support as an integrated part of their interdisciplinary pain rehabilitation. The patients’ experiences were investigated through semi-structured interviews 3 months after inclusion in the study.ResultsThe participants reported mostly positive experiences with IPS. One participant dropped out of the study after deterioration of symptoms, while the remaining participants were satisfied with the intervention. Particular helpful aspects of the IPS intervention were the follow-up from the employment specialist, focus on competitive employment, focus on work despite pain complaints, reframing work into something positive, administrative support, and practice in writing applications. No participants reported adverse experiences from the IPS intervention. Within a 12-months time frame, 3 of the 8 participants gained competitive employment.ConclusionsThis is the first report of the IPS model of supported employment applied in an outpatient setting for chronic pain patients. The results suggest that IPS can be successfully integrated with interdisciplinary pain rehabilitation, and warrants large-scale testing in a randomized controlled trial.

Exploring the views of stakeholders about the feasibility of carrying out a randomised controlled trial of Individual Placement and Support for people unemployed with chronic pain based in primary care (the InSTEP study)

“…Re-employment rates are well-known to be much lower after prolonged unemployment, due to a complex array of factors including physical and mental health impacts, loss of confidence and self-efficacy, deskilling and financial dependence on welfare benefits [33][34][35][36][37][38]. The views expressed reinforce our own view that a future trial needs to investigate early IPS particularly given that the Norwegian trial is recruiting pain patients with > 2 years' unemployment [14].…”

“…It appears that clients referred to the Solent Jobs Programme, a pre-condition for which is that they should be choosing to try and obtain employment, were uncertain of their agency and felt some compulsion to engage because they perceived a risk of losing their welfare benefit payments. Perhaps because of cultural differences, or differences in national health and welfare systems, no such problems were reported in the recent Norwegian pilot study [14]. In developing a UK clinical trial, researchers will need to be sensitive to this complexity and make every effort to enable participants to give written informed consent to the research.…”

“…Despite the success of this approach amongst people with severe mental ill-health [11][12][13], this approach has not yet been tested much for other health conditions. One recent Norwegian pilot study evaluated IPS amongst 8 chronic pain patients and found positive impacts, particularly on function [14]. There was one drop out, but 3/8 obtained competitive employment over 12 months, and a full randomised controlled trial (RCT) [15] is currently in progress.…”

Individualised placement support as an employment intervention for individuals with chronic pain: a qualitative exploration of stakeholder views

“…14,15 Given the success for individuals with mental health conditions, IPS may also be a successful strategy for patients with chronic pain. 16 The principles of IPS may be beneficial to individuals with chronic pain, assisting them to gain employment through identifying their needs, integration with pain services, and individualised support. The overall objective of this study was to explore needs and benefits in relation to IPS for patients with chronic pain, as well as relevant stakeholder views of the intervention.…”

Protocol for the Individual Placement and Support (IPS) in Pain Trial: A randomized controlled trial investigating the effectiveness of IPS for patients with chronic pain

“…Pain is an experience that involves affective, motivational, and sensory components [ 19 , 20 ], and given the similarities and overlap between mental illness and chronic pain [ 21 – 24 ], an investigation of repurposing IPS to chronic pain appears promising. Indeed, in a previous pilot study conducted to inform this trial, participants reported mostly positive experiences with IPS as an integrated part of their interdisciplinary pain rehabilitation [ 25 ].…”