Chronic pain management in a health maintenance organization

Abstract

Objective: The purpose of this study is to investigate the management of chronic pain in a large health maintenance organization using cognitive-behavioral techniques and a blinded control group.

Design: Subjects were randomized into two groups. All participants completed a self-administered baseline questionnaire and were mailed a self-administered 6-month follow-up questionnaire.

Setting: This study examines chronic pain management in a large, established health maintenance organization.

Patients: Patients were members of a health maintenance organization, had pain for at least 6 months, and had failed all known treatment regimens.

Interventions: The treatment group participated in a 16-hour, 8-week class teaching cognitive-behavioral techniques, the relaxation response, meditation, and stress management. The minimal treatment group received a home-study manual.

Outcome measures: Behavioral outcomes, function, and pain severity and also patient satisfaction were measured.

Results: Both the treatment and minimal treatment groups exhibited improvement in pain severity, negative mood, pain affect, and pain interference with the patient's life.

Conclusion: Gains were achieved in pain severity, negative mood, pain affect, self-control, and pain interference with the patient's life. Other behavioral variables and activity did not improve. Except in self-control, pain affect, and distracting responses from their significant others, the blinded minimal treatment group demonstrated similar findings. Patient satisfaction with treatment strongly favored the treatment group with over 78% of the treatment participants satisfied with the care provided.