What Influences Outcomes From Inpatient Multidisciplinary Pain Management Programs?

Abstract

Objectives: Although inpatient multidisciplinary pain management programs (PMPs) are effective for chronic pain, not all patients benefit equally and there is limited evidence regarding predictors of outcome. This meta-analysis aimed to identify patient or program characteristics associated with outcomes from inpatient PMPs, and to examine the time course of effects following discharge.Materials and Methods: Medline, EBSCO, and Scopus were searched to identify articles reporting outcomes from inpatient multidisciplinary PMPs. Information was extracted on study design, participant and program characteristics, and outcomes. Effect sizes were computed for pain, physical function, depression, anxiety, and mental health outcomes. Study-level predictors of outcome were investigated with moderator analyses and meta-regression. A risk of bias assessment and sensitivity analyses were conducted and the GRADE criteria for prognostic studies were applied to assess confidence in findings.Results: In all, 85 studies (111 cohorts; 15,255 participants) were included. Three quarters of studies demonstrated low risk of bias. Larger effect sizes (for at least 1 outcome measure) occurred in studies where participants had more severe pain (greater intensity/ longer duration), participants with alcohol or drug problems were not excluded, samples comprised mixed pain conditions, and programs included a cognitive component and/or a passive therapy component. Effect sizes for pain and physical function were maintained at follow-up, but effect sizes for depression and anxiety declined over time.Discussion: Inpatient multidisciplinary PMPs may be well suited to patients with severe or long-lasting pain. Programs should adopt broad patient inclusion criteria, and outcomes were similar for programs based on cognitive-behavioral versus mindfulness/ acceptance-based therapies.

Complex association between post-COVID-19 condition and anxiety and depression symptoms

“…Chronic self-reported anxiety (i.e., present before the COVID-19 pandemic) was significantly more frequent in the PCC group compared with the control group, which is consistent with the identification of pre-infection psychiatric comorbidities as risk factors for PCC [ 22 , 23 , 39 ]. These data support the broader literature linking anxiety and depression with the occurrence or persistence of physical symptoms [ 17 – 20 ], thus suggesting possible causal pathways and shared vulnerability factors.…”

“…At the same time, the prevalence of anxiety and depressive symptoms and disorders substantially increased between the pre-and mid-pandemic periods in the general population [9,10] and more intensely in people with COVID-19 [11][12][13][14][15][16]. It has been suggested that anxiety and depression may play a role in the persistence of certain physical symptoms such as fatigue, sleep disorders, digestive disorders, and pain [17][18][19][20]. Indeed, a pre-infection diagnosis of anxiety or depression is a risk factor for persistent symptoms following SARS-CoV-2 infection [21][22][23], and depression at 1 month of SARS-CoV-2 infection is associated with an increased risk of persistent physical symptoms at 3 months, including pain and dyspnea [24].…”

Expectations of treatment outcome in complex cases of patients with chronic pain: A study on the DATAPAIN cohort

“…Moreover, Poulsen et al 23 indicated that pain catastrophizing does not have a predictive role in the outcome of pain relief in spinal cord stimulation for chronic neuropathic pain. Yet, most studies do indicate pain catastrophizing as a predictor of pain outcomes such as pain intensity, 24–29 just like the presence of depression and anxiety at baseline are seen as predictors of worse pain outcome 9,26–30 . The results of this study suggest that although high pain severity and psychological values were present, complex cases do not respond differently in pain intensity.…”

“…Yet, most studies do indicate pain catastrophizing as a predictor of pain outcomes such as pain intensity, [24][25][26][27][28][29] just like the presence of depression and anxiety at baseline are seen as predictors of worse pain outcome. 9,[26][27][28][29][30] The results of this study suggest that although high pain severity and psychological values were present, complex cases do not respond differently in pain intensity. However, in our recent study on drug and interventional RCT's and the DATAPAIN registry cohort, greater pain relief at follow-up was found at follow-up in patients with severe pain (≥ 7 on the NRS) 31,32 The finding of a similar pain relief in both groups may suggest that the cluster of cognitive-affective, psychological factors and pain severity reduces the pain relief because a greater reduction in pain intensity could theoretically be obtained in patients with a high pain score at baseline.…”

Acceptance and Fear-Avoidance Mediate Outcomes of Interdisciplinary Pain Rehabilitation Programs at 12-Month Follow-Up: A Clinical Registry-Based Longitudinal Cohort Study from the Swedish Quality Registry for Pain Rehabilitation (SQRP)

“… 4 , 5 , 34 , 37 Moreover, a recent systematic review concluded that higher pain intensity and longer pain duration were associated with larger effect sizes for several IPRP outcomes. 38 As this study examines real-world data and as previous real-world studies have shown that a more severe clinical picture is associated with better results, we hypothesize that the baseline values of pain intensity and psychological distress would show positive associations with the three outcomes ( Figure 1 ).…”