Clinical and Demographic Predictors of Interdisciplinary Chronic Pain Rehabilitation Program Treatment Response

Huffman, K.; Mandell, Darcy; Lehmann, Jennifer; Jiménez, Xavier F.; Lapin, Brittany

doi:10.1016/j.jpain.2019.05.014

Cited by 13 publications

(18 citation statements)

References 81 publications

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“…Finding that pre-IPP opioid status predicted attrition prompts new research questions and hypotheses. Like our findings, earlier studies have shown that patients with preintervention opioid use benefit from interdisciplinary pain rehabilitation programs (Gilliam et al, 2018; Huffman et al, 2019). Specifically, our follow-up analyses revealed that 24 of 37 completers (65%) on opioids at preintervention reduced or eliminated use over the course of the program, typically reducing by about 10% each week of the program.…”

Section: Discussionsupporting

confidence: 88%

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Predictors of attrition in an interdisciplinary pain management program.

Chong¹

2023

Rehabilitation Psychology

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Purpose/Objective: This study sought to investigate the extent to which demographic and clinical characteristics predict which patients drop out of an interdisciplinary pain management program (IPP). Research Method/Design: Participants (N = 178 outpatients, 18–75 years of age) received treatment for various chronic pain conditions in an IPP (including biopsychosocial assessment, cognitive–behavioral, and physical therapies). Separate logistic regression analyses identified the demographic and clinical variables most predictive of attrition across five domains: (a) demographics, (b) number of medical and non/psychiatric diagnoses, (c) opioid use (yes versus no)/risk of misuse, (d) pain-related cognition and behavior, and (e) physical, social, and mental well-being. Significant predictors from the five domains were integrated in a final multivariable logistic regression model. Results: Among patients exposed to a 4-week IPP, 34% dropped out. In the final model, significant predictors of higher odds of attrition included younger age or being unemployed. Also, patients on opioids at preintervention had higher odds of completing the IPP than patients not on opioids at preintervention. Follow-up analyses revealed 24 of 37 completers (65%) on opioids at preintervention reduced or eliminated use over the course of the IPP. Conclusions/Implications: Because findings are limited by sample and design characteristics, they require replication yet offer novel hypotheses for identifying patients at risk of attrition. Specifically, patients with preintervention opioid use (contrasted with opioid dependence) may particularly benefit from an IPP. Patients at highest risk for early dropout can be targeted for specific engagement interventions to promote completion and effectiveness of IPP.

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Section: Discussionsupporting

confidence: 88%

“…These programs have been shown to be not only therapeutically efficacious but also cost-effective (Gatchel et al, 2014; Gatchel & Turk, 1999; Okifuji et al, 1999). Additionally, studies have linked rehabilitation in an IPP with successful opioid tapering (Gilliam et al, 2018; Huffman et al, 2019).…”

Section: Introductionmentioning

confidence: 99%

Predictors of attrition in an interdisciplinary pain management program.

Chong¹

2023

Rehabilitation Psychology

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“…As shown in Figure 1 , the 39 studies used a broad range of research designs; nineteen randomized controlled trials (RCTs) [ 2 , 7 , 29 , 30 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 , 52 ], eighteen non-randomized observational studies (e.g., prospective and retrospective cohort studies, case studies, quasi-experimental studies) [ 1 , 3 , 5 , 10 , 14 , 53 , 54 , 55 , 56 , 57 , 58 , 59 , 60 , 61 , 62 , 63 , 64 , 65 ], and two secondary analyses of RCTs [ 66 , 67 ] met the inclusion criteria. The final 39 articles were tabled and analyzed according to the level of hierarchy ( Table 1 below and supplementary material Table S1 : Characteristics of Included Studies).…”

Section: Resultsmentioning

confidence: 99%

The Impact of Nonpharmacological Interventions on Opioid Use for Chronic Noncancer Pain: A Scoping Review

Coffee,

Cheng,

Slebodnik

et al. 2024

IJERPH

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Despite the lack of evidence, opioids are still routinely used as a solution to long-term management for chronic noncancer pain (CNCP). Given the significant risks associated with long-term opioid use, including the increased number of unregulated opioid pills at large in the opioid ecosystem, opioid cessation or reduction may be the desired goal of the patient and clinician. Viable nonpharmacological interventions (NPIs) to complement and/or replace opioids for CNCP are needed. Comprehensive reviews that address the impact of NPIs to help adults with CNCP reduce opioid use safely are lacking. We conducted a literature search in PubMed, CINAHL, Embase, PsycINFO, and Scopus for studies published in English. The initial search was conducted in April 2021, and updated in January 2024. The literature search yielded 19,190 relevant articles. Thirty-nine studies met the eligibility criteria and underwent data extraction. Of these, nineteen (49%) were randomized controlled trials, eighteen (46%) were observational studies, and two (5%) were secondary analyses. Among adults with CNCP who use opioids for pain management, studies on mindfulness, yoga, educational programs, certain devices or digital technology, chiropractic, and combination NPIs suggest that they might be an effective approach for reducing both pain intensity and opioid use, but other NPIs did not show a significant effect (e.g., hypnosis, virtual reality). This review revealed there is a small to moderate body of literature demonstrating that some NPIs might be an effective and safe approach for reducing pain and opioid use, concurrently.

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“…Persons living in rural or lower income communities and persons of Hispanic/Latino ethnicity experience disparities in chronic pain prevalence and management 14 90 91. Although evidence-based guidelines recommend NP care as first-line management, implementation has lagged, particularly in these communities 19 92 93.…”

Section: Discussionmentioning

confidence: 99%

BeatPain Utah: study protocol for a pragmatic randomised trial examining telehealth strategies to provide non-pharmacologic pain care for persons with chronic low back pain receiving care in federally qualified health centers

et al. 2022

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IntroductionAlthough evidence-based guidelines recommend non-pharmacologic treatments as first-line care for chronic low back pain (LBP), uptake has been limited, particularly in rural, low-income and ethnically diverse communities. The BeatPain study will evaluate the implementation and compare the effectiveness of two strategies to provide non-pharmacologic treatment for chronic LBP. The study will use telehealth to overcome access barriers for persons receiving care in federally qualified health centres (FQHCs) in the state of Utah.Methods and analysisBeatPain Utah is a pragmatic randomised clinical trial with a hybrid type I design investigating different strategies to provide non-pharmacologic care for adults with chronic LBP seen in Utah FQHCs. The intervention strategies include a brief pain consult (BPC) and telehealth physical therapy (PT) component provided using either an adaptive or sequenced delivery strategy across two 12-week treatment phases. Interventions are provided via telehealth by centrally located physical therapists. The sequenced delivery strategy provides the BPC, followed by telehealth PT in the first 12 weeks for all patients. The adaptive strategy uses a stepped care approach and provides the BPC in the first 12 weeks and telehealth PT to patients who are non-responders to the BPC component. We will recruit 500 English-speaking or Spanish-speaking participants who will be individually randomised with 1:1 allocation. The primary outcome is the Pain, Enjoyment and General Activity measure of pain impact with secondary outcomes including the additional pain assessment domains specified by the National Institutes (NIH) of Health Helping to End Addiction Long Initiative and implementation measures. Analyses of primary and secondary measures of effectiveness will be performed under longitudinal mixed effect models across assessments at baseline, and at 12, 26 and 52 weeks follow-ups.Ethics and disseminationEthics approval for the study was obtained from the University of Utah Institutional Review Board. On completion, study data will be made available in compliance with NIH data sharing policies.Trial registration numberNCT04923334.

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Clinical and Demographic Predictors of Interdisciplinary Chronic Pain Rehabilitation Program Treatment Response

Cited by 13 publications

References 81 publications

Predictors of attrition in an interdisciplinary pain management program.

Predictors of attrition in an interdisciplinary pain management program.

The Impact of Nonpharmacological Interventions on Opioid Use for Chronic Noncancer Pain: A Scoping Review

BeatPain Utah: study protocol for a pragmatic randomised trial examining telehealth strategies to provide non-pharmacologic pain care for persons with chronic low back pain receiving care in federally qualified health centers

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