Characterization of complex chronic pain patients

AimsTreatment of the most complex chronic pain patients, often not accepted in regular pain management programs, remains a challenge.To beable todesign interventions for these patients we must know what characterize them. The aim of this study was to characterize a subgroup of pain patients, treated in our in-patient rehabilitation programme, organized at the University Hospital in Uppsala, the only tertiary treatment for pain patients in Sweden.MethodsThe study was approved by the Regional Ethical Review Board in Uppsala (Dnr 2010/182). Seventy-two patients, consecutive new referrals seen at the rehabilitation program in 2008–2010 were enrolled and examined with a 41-item questionnaire of symptoms other than pain. The 41 symptoms were listed on an ordinal scale from 0–10, with 0–no problems and 10–severe problem. The mean pain intensity within the preceding 24-h was assessed using an 11-point NRS, numeric rating scale from 0–no problems to 10–severe problems. Information about drug-consumption was obtained from the medical record. The opioid medication was translated to morphine-equivalents dos using EAPC (European Association for Palliative Care) conversion table.ResultsSeventy-two patients were enrolled and screened, 39% men and 61% woman. Median age 45 years (range 20–70). Seventy-four percent of patients were treated with opioids, 15 patients with more than one opioid. They all reported high pain intensity, the four patients with doses over 150 mg MEq reported pain 5–8. There was no correlation between the dose of opioids and pain intensity. The patients reported 22 symptoms (median) other than pain. The number of symptoms reported using this scaleina normal population is three–four. The most common symptoms reported were lethargy, tiredness, concentration difficulties and headache reported by over 80%. Sleeping disorders and tiredness were considered as the two most problematic symptom to deal with. We found no correlation between the degree of pain and presence and severity of symptoms reported. Number of symptoms reported diminished when the dose of opioids increased.ConclusionsThe pain patient considered too complex for regular pain-management programs are characterized by reporting many symptoms other than pain. High pain intensity or high opioid-dose does not correlate to presence or severity of other symptoms, and high dose of opioids does not have a connection to low pain intensity. Many of the symptoms commonly reported – lethargy, tiredness, concentration difficulties and headache are real obstacles for successful rehabilitation, and have to be dealt with to achieve successful results.