Predicting factors of outcome in multidisciplinary treatment of chronic neuropathic pain

Shaygan, Maryam; Böger, Andreas; Kröner‐Herwig, Birgit

doi:10.2147/jpr.s175817

Cited by 29 publications

(29 citation statements)

References 57 publications

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“…Multidisciplinary care in chronic neuropathic pain has been shown to statistically significantly decrease pain and improve function, mood, catastrophizing, and pain acceptance [45]. Clinically significant changes of greater than two points on a VAS scale were seen immediately post-treatment, but only 49% of patients maintained this level of pain reduction at three-month follow-up.…”

Section: Resultsmentioning

confidence: 99%

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A Comprehensive Algorithm for Management of Neuropathic Pain

Bates

Schultheis

Hanes³

et al. 2019

Pain Medicine

285

208

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Background The objective of this review was to merge current treatment guidelines and best practice recommendations for management of neuropathic pain into a comprehensive algorithm for primary physicians. The algorithm covers assessment, multidisciplinary conservative care, nonopioid pharmacological management, interventional therapies, neurostimulation, low-dose opioid treatment, and targeted drug delivery therapy. Methods Available literature was identified through a search of the US National Library of Medicine’s Medline database, PubMed.gov. References from identified published articles also were reviewed for relevant citations. Results The algorithm provides a comprehensive treatment pathway from assessment to the provision of first- through sixth-line therapies for primary care physicians. Clear indicators for progression of therapy from firstline to sixth-line are provided. Multidisciplinary conservative care and nonopioid medications (tricyclic antidepressants, serotonin norepinephrine reuptake inhibitors, gabapentanoids, topicals, and transdermal substances) are recommended as firstline therapy; combination therapy (firstline medications) and tramadol and tapentadol are recommended as secondline; serotonin-specific reuptake inhibitors/anticonvulsants/NMDA antagonists and interventional therapies as third-line; neurostimulation as a fourth-line treatment; low-dose opioids (no greater than 90 morphine equivalent units) are fifth-line; and finally, targeted drug delivery is the last-line therapy for patients with refractory pain. Conclusions The presented treatment algorithm provides clear-cut tools for the assessment and treatment of neuropathic pain based on international guidelines, published data, and best practice recommendations. It defines the benefits and limitations of the current treatments at our disposal. Additionally, it provides an easy-to-follow visual guide of the recommended steps in the algorithm for primary care and family practitioners to utilize.

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Section: Resultsmentioning

confidence: 99%

“…The average pain relief at this time was 1.3 on a 10-point numeric pain scale. Similarly, early gains in depression were lost by three months, whereas the significant gains in catastrophizing and pain acceptance were maintained [45].…”

Section: Resultsmentioning

confidence: 99%

A Comprehensive Algorithm for Management of Neuropathic Pain

Bates

Schultheis

Hanes³

et al. 2019

Pain Medicine

285

208

View full text Add to dashboard Cite

show abstract

“…Helplessness can in turn affect an individual's understanding of his/her ability in coping with pain as a secondary assessment and the patient feel that he/she is more weakened than what he/she thinks (36). It also seems that since the presence of depressive symptoms in patients can interfere with daily activities and participation in social activities, it increases the patient's disability (37).…”

Section: Discussionmentioning

confidence: 99%

Predictive Factors for Disability in Patients with Acute and Chronic Headache

et al. 2019

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Background: Headache is one of the most common types of pain which is considered among the most disabling of diseases. However, the severity of disability in some headache patients is more than others. Objectives: The aim of the present study was to compare different types of headache regarding pain-related variables and psychological factors. We also examined the predicting factors of disability in patients with headache. Methods: This cross-sectional study was performed in 320 patients with various types of headache based on the International Headache Society criteria, which was assessed by neurologists. Data was collected using migraine disability assessment for disability, frequency of headache and for pain intensity, patient health questionnaire for depression, and pain anxiety symptoms scale for pain-related anxiety. ANOVAs and post hoc Tukey's tests were used for comparing various types of headaches regarding pain-related and psychological factors. Regression analyses assessed the relation of pain-related and psychological variables with disability. Results: Patients with different types of headache revealed no significant differences regarding pain intensity (P = 0.27). Migraine patients showed the most pain frequency and chronicity compared to the other patients (P = 0.000). The levels of disability (P = 0.000), anxiety (P = 0.000) and depressive symptoms (P = 0.000) were also higher in patients with migraine compared to patients suffering from cluster or tension type headache. Pain chronicity (P = 0.01), anxiety (P = 0.007) and depression (P = 0.002) made significant contributions to the explanation of variance in 'disability'. Conclusions: The findings add further evidence to the relevance of cognitive-behavioral models of pain suggesting an important role for pain-related emotions regarding the consequences of pain (e.g. disability). The current data could help clinicians to decide which factors should be considered for a successful treatment of disability in headache patients.

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“…Acceptance of pain is defined by the acknowledgment that one can be in pain and at the same is capable of making efforts to live a satisfying life 12. Depression,14,15 catastrophizing14,16,17 and acceptance12–15 are among the most widely studied factors modulating pain and disability.…”

Section: Introductionmentioning

confidence: 99%

<p>How does reduction in pain lead to reduction in disability in patients with musculoskeletal pain?</p>

Shaygan¹,

Böger²,

Kröner‐Herwig³

2019

JPR

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Purpose Reduction in pain following multidisciplinary treatment is most often associated with a reduction in disability. To further elaborate the relationship between pain intensity and disability, the present study investigated three main questions: first, whether multidisciplinary treatment leads to a significant improvement in pain, disability and psychological variables (depression, pain acceptance and catastrophizing). Second, it was examined whether pain reduction may account for significant changes in the psychological variables (pre- to follow-up change scores). Finally, it was analyzed whether the psychological changes mediate the association between reduction in pain and in disability after controlling for age, sex and pain history. Patients and methods Patients suffering from chronic musculoskeletal pain (n=279) attended a German inpatient multidisciplinary program lasting 15 consecutive days on average, with self-report data collected at pretreatment, posttreatment and three-month follow-up. Results Repeated measures ANOVAs showed a significant improvement in pain intensity, disability, pain acceptance, catastrophizing and depression at posttreatment and follow-up. Univariate regression analyses revealed that changes in pain intensity accounted for significant changes in depression, pain catastrophizing and pain acceptance (pre- to follow-up change scores). The results of Multiple Mediation Procedure showed that pain reduction did affect reduction in disability through improvement of depression, catastrophizing and acceptance. Conclusion Our findings support a cognitive-behavioral model of pain that posits an important role for pain-related cognitive and emotional processes in long-term outcomes following multidisciplinary pain treatment, in particular for the modulation of disability due to pain. The results add evidence to the notion that pain-related cognitions are dynamic features varying over time dependent on the internal situation. Perspective The current findings are relevant to the management of patients with musculoskeletal pain. The results support the notion that, in contrast with the view of enduring personality traits, pain-related cognitions and emotions reflect a situational response that varies over time.

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Predicting factors of outcome in multidisciplinary treatment of chronic neuropathic pain

Cited by 29 publications

References 57 publications

A Comprehensive Algorithm for Management of Neuropathic Pain

A Comprehensive Algorithm for Management of Neuropathic Pain

Predictive Factors for Disability in Patients with Acute and Chronic Headache

<p>How does reduction in pain lead to reduction in disability in patients with musculoskeletal pain?</p>

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