The Individual Placement and Support (IPS) in Pain Trial: A Randomized Controlled Trial of IPS for Patients with Chronic Pain Conditions

Abstract

Objectives Although complex pain conditions require an interdisciplinary approach, employment services are rarely provided in pain centers. Individual Placement and Support (IPS) is an effective approach to increase work participation among patients with severe mental illness, and recent evidence suggests that this method may be successfully repurposed to new target groups. We aimed to investigate the effectiveness of IPS integrated with interdisciplinary treatment as usual (TAU) for patients with chronic pain in a tertiary pain center. Methods A randomized controlled trial (RCT) comparing IPS integrated with TAU (n = 38) with TAU alone (n = 20) was conducted. Participants were patients with chronic pain; aged 18–65; currently on long-term sick leave, disability benefits, or unemployed. The primary outcome was employment within 12 months after enrollment, with additional long-term follow-up after 24 months. Secondary outcomes included health and quality of life, measured at baseline, 6 and 12 months. Results During 12-month follow-up 52.8% in the IPS group and 38.9% in the TAU group had attained employment. The difference increased during 24-month follow-up, but did not reach statistical significance. Findings on secondary outcomes were generally non-significant. Conclusions The IPS in Pain trial is the first study to evaluate the effect of IPS for patients with chronic pain conditions. It shows that IPS can be integrated into daily practice of interdisciplinary pain treatment with employment rates exceeding 50% in one year, and a clear trend in favor of the IPS group. Results did however not reach significance. Larger RCTs are needed to draw clear conclusions about effectiveness.

Individual placement and support: History, current status, and future directions

“…Two others found significant employment outcomes favoring IPS for young adults with health conditions at risk for long‐term disability 129 and for military veterans with substance use and criminal justice involvement 124 . The small pilot RCT of IPS for pain patients, however, did not find a significant effect for IPS, possibly because it was underpowered 130 …”

“…The extension of IPS to new populations is a relatively recent development. Figure 1 summarizes 13 RCTs of IPS for working‐age adults with conditions other than serious mental illness 118–130 . Only three of these RCTs were completed before 2016 120,126,127 .…”

“…124 The small pilot RCT of IPS for pain patients, however, did not find a significant effect for IPS, possibly because it was underpowered. 130 Research on IPS for new populations ranges across groups from nonexistent to several studies, but many areas obviously need more work. Examples include IPS programs for people in different stages of justice-system involvement; people with primary substance use disorders 131,132 ; refugees 133 Minor adaptations for context are common.…”

“…Figure 1 summarizes 13 RCTs of IPS for working‐age adults with conditions other than serious mental illness. 118 , 119 , 120 , 121 , 122 , 123 , 124 , 125 , 126 , 127 , 128 , 129 , 130 Only three of these RCTs were completed before 2016. 120 , 126 , 127 These RCTs include four completed since the publication of a meta‐analyses of IPS for other populations discussed earlier.…”

Arbeidsrettet behandling ved alvorlig psykisk lidelse i spesialisthelsetjenesten

“…Dette er et prisverdig mål, men er en arbeidsrehabiliteringsmodell utviklet for de med alvorlige psykiske lidelser rett virkemiddel? Er det fornuftig bruk av ressurser?IPS ved posttraumatisk stresslidelse (Mueller et al, 2019) og kronisk smerte (Sveinsdottir et al, 2022) har vist gode resultater når det gjelder å komme i ordinaert lønnet arbeid. Det samme gjelder unge i fare for å falle utenfor arbeid og utdanning (Sveinsdottir et al, 2020).…”