Assessing benefits of the pain center: Why some patients regress

Abstract

Pain centers meet success in dealing with many cases of chronic pain which had been refractory to other therapies. Unfortunately, about one-fourth of all patients who initially do well begin to deteriorate shortly after completion, and within a few months have regressed to pre-treatment levels. In an effort to understand the causes of this regression, the authors surveyed patients who completed the program in 1977 by means of mail questionnaire. The 25 most successful patients were contrasted with an equal cohort of failures (i.e., patients who had met with initial success and subsequent regression). Correlations were also performed among indices of change and other variables. The failure group demonstrated less incentive for maintaining their gains, most continuing to receive financial compensation for their pain. Differences in attitude were revealed, with the failure group more likely to assume a dependent, passive stance. Depression was more characteristic of the failure group and may be causative with respect to deterioration. Most strinkingly, it appeared that the failure group had done little to change their environments, and continued to find reinforcement for pain behavior following discharge. The survey suggests the need for changes in the area of employment for injured workers, as well as further research in attitude measurement and attitude change. More aggressive treatment of depression might reduce the tendency toward regression, as would increased effort to change family dynamics that reward the patient for overt suffering.

Depression and Pain Comorbidity

“…38,52 Patients with depression and chronic pain were less likely to comply with pain rehabilitation and thus more likely to relapse following treatment. 121,122 Although most studies (Table 3) support the finding that patients with pain and depression have poorer overall response to treatment than pain patients without depression, a few did not report such a relationship. 55,121,129,130 …”

Emotional Health Predicts Pain and Function After Fusion: A Prospective Multicenter Study

“…40 The term "depression-pain syndrome" 41 has been coined to refer to the comorbidity noted between pain and depression, with evidence that having pain (or depression) appears to make depression (or pain) worse 42 and that depression correlates with poor outcomes. 43,44 Depression and pain may share common dysregulation of neurotransmitters, and, thus, both might be treated with antidepressants. 45,46 Although there is strong evidence that cognitive behavioral therapy can improve depression, 47 the studies on treating depression and pain have most often focused on antidepressant medications, with mixed results reported.…”

Early Identification of Co-Occurring Pain, Depression and Anxiety

“…The importance of recognizing and treating depression and anxiety among patients with pain is critical as there is evidence that psychological distress may amplify pain and impair the person's capacity to adapt to severe pain, 11 and have a substantial effect on treatment response in those with chronic pain. 2,[12][13][14] Yet detection of both depression and anxiety is typically low in primary care settings (less than 50%), possibly because such patients present primarily with somatic complaints, 60% of which are pain related. 2 A study by Katon 15 projected that if all primary care patients presenting with pain conditions were evaluated for possible depression, 60% of previously undetected depression cases might be recognized, underscoring the importance of integrating pain and distress recognition.…”