Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2020 Aug 29;9(9):2788.
doi: 10.3390/jcm9092788.

What Is the Effectiveness of Different Duration Interdisciplinary Treatment Programs in Patients with Chronic Pain? A Large-Scale Longitudinal Register Study

Elena Tseli  1   2 , Riccardo LoMartire  1   2 , Linda Vixner  2 , Wilhelmus Johannes Andreas Grooten  1   3 , Björn Gerdle  4 , Björn O Äng  1   2   5
Affiliations

What Is the Effectiveness of Different Duration Interdisciplinary Treatment Programs in Patients with Chronic Pain? A Large-Scale Longitudinal Register Study

Elena Tseli et al. J Clin Med. .

Abstract

Chronic pain is a leading cause of disability globally. Interdisciplinary multimodal pain rehabilitation (IMPR) targets pain with a bio-psycho-social approach, often delivered as composite programs. However, evidence of optimal program duration for the rehabilitation to succeed remains scarce. This study evaluated the effectiveness of different duration IMPR-programs-using within- and between-effects analyses in a pragmatic multicenter register-based controlled design. Using the Swedish Quality Registry for Pain Rehabilitation, data from fifteen clinics specialized in chronic pain rehabilitation across Sweden were retrieved. Participants were patients with chronic musculoskeletal pain who had taken part in short (4-9 weeks; n = 924), moderate (10 weeks; n = 1379), or long (11-18 weeks; n = 395) IMPR programs. Longitudinal patient-reported outcome data were assessed at baseline, post-intervention, and at a 12-month follow-up. Primary outcomes were health-related quality of life, presented as perceived physical and mental health (SF-36). Secondary outcomes included the Hospital Anxiety and Depression Scale (HADS), pain intensity (NRS 0-10), the Multidimensional Pain Inventory (MPI), and perceived health (EQ-5D). Overall, all groups showed improvements. No clinically important effect emerged for different duration IMPR. In conclusion, while our results showed that patients following IMPR report improvement across a bio-psycho-social specter, a longer program duration was no more effective than a shorter one.

Keywords: multidisciplinary pain management; outcome measures; physical and mental functioning; practice-based evidence; registry study.

PubMed Disclaimer

Conflict of interest statement

The authors declare no conflict of interest. The funders had no role in the design of the study; in the collection, analyses, or interpretation of data; in the writing of the manuscript, or in the decision to publish the results.

Figures

Figure 1
Figure 1
Flow chart of research design and patient participation, treatment duration and evaluation. SQRP: Data from the Swedish Quality Registry for Pain Rehabilitation. IMPR: Interdisciplinary multimodal pain rehabilitation.
Figure 2
Figure 2
Change of health-related QoL from baseline to post intervention and 12 months follow-up, measured by SF-36 Physical Component Summary (PCS), Mental Component Summary (MCS). High values indicate better status. In the model, adjustment was made for baseline status and treatment days/week. Note: graphs show unadjusted baseline values, while statistical analysis was controlled for differences at baseline. Dashed lines indicate norm value for general population.
Figure 3
Figure 3
Figure illustrates minimal clinically important difference (MCID) for primary and secondary outcomes at post-intervention and 12-month follow up. Positive bars (green) show proportion of patients that improved while negative (red) shows proportion of patients that deteriorated.
See this image and copyright information in PMC

References

    1. Merskey H., Bogduk N. Classification of Chronic Pain: Descriptions of Chronic Pain Syndromes and Definitions of Pain Terms. 2nd ed. IASP Press; Seattle, WA, USA: 1994. International Association for the Study of Pain. Task Force on, T.
    1. Leadley R.M., Armstrong N., Lee Y.C., Allen A., Kleijnen J. Chronic diseases in the European Union: The prevalence and health cost implications of chronic pain. J. Pain Palliat. Care Pharmacother. 2012;26:310–325. doi: 10.3109/15360288.2012.736933. - DOI - PubMed
    1. Raffaeli W., Arnaudo E. Pain as a disease: An overview. J. Pain Res. 2017;10:2003–2008. doi: 10.2147/JPR.S138864. - DOI - PMC - PubMed
    1. Turk D.C., Dworkin R.H., Revicki D., Harding G., Burke L.B., Cella D., Cleeland C.S., Cowan P., Farrar J.T., Hertz S., et al. Identifying important outcome domains for chronic pain clinical trials: An IMMPACT survey of people with pain. Pain. 2008;137:276–285. doi: 10.1016/j.pain.2007.09.002. - DOI - PubMed
    1. Vos T., Abajobir A.A., Abate K.H., Abbafati C., Abbas K.M., Abd-Allah F., Abdulkader R.S., Abdulle A.M., Abebo T.A., Abera S.F., et al. Global, regional, and national incidence, prevalence, and years lived with disability for 328 diseases and injuries for 195 countries, 1990–2016: A systematic analysis for the Global Burden of Disease Study 2016. Lancet. 2017;390:1211–1259. doi: 10.1016/S0140-6736(17)32154-2. - DOI - PMC - PubMed