Detection of systemic inflammation in severely impaired chronic pain patients, and effects of a CBT-ACT-based multi-modal pain rehabilitation program

AbstractAimsA few previous studies indicate an ongoing of low-grade systemic inflammation in chronic pain patients (CPP) [1, 2]. In the present study we investigated the plasma inflammatory profile in severely impaired chronic pain patients. In addition we studied if there were any alterations in inflammation patterns at one-year follow up, after the patients had taken part in a CBT-ACT based 4 weeks in-hospital pain rehabilitation program (PRP).Methods Blood samples were collected from 52 well characterized chronic pain patients. Plasma from matched healthy blood donors were used as controls. At one year after the treatment program, 28 of the patients were available for follow up. Instead of only analyzing single inflammation-related substances, we used a new multiplex panel enabling the simultaneous analysis of 92 inflammation-related proteins, mainly cytokines and chemokines (Proseek Inflammation, Olink, Uppsala, Sweden). Multivariate statistics were used for analysis.ResultsClear signs of increased inflammatory activity were detected in the pain patients. Accepting a false discovery rate (FDR) of 5%, there were significant differences in 43 of the 92 inflammatory biomarkers. The expression of 8 biomarkers were 4 times higher in patients compared to controls. Three biomarkers, CXCL5, SIRT2, AXIN1 were more than 8 times higher. The conventional marker for inflammation, CRP, did not differ. Of the 28 patients available for follow up one year after the intervention, all showed lower levels of the inflammatory biomarker initially raised.ConclusionsThe results indicate that CPP suffer from a low grade of chronic systemic inflammation, not detectable by CRP analysis. This may have implications for the general pain hypersensitivity, and other symptoms, often described in this group of patients. We conclude that inflammatory plasma proteins may be measureable molecular markers to distinguishes CPP from pain free controls, and that a CBT-ACT pain rehab program seem to decrease this inflammatory activity.

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Detection of systemic inflammation in severely impaired chronic pain patients and effects of a multimodal pain rehabilitation program

Scandinavian Journal of Pain ◽

10.1515/sjpain-2018-0340 ◽

2019 ◽

Vol 19 (2) ◽

pp. 235-244 ◽

Cited By ~ 9

Author(s):

Eva-Britt Hysing ◽

Lena Smith ◽

Måns Thulin ◽

Rolf Karlsten ◽

Kristoffer Bothelius ◽

...

Keyword(s):

Chronic Pain ◽

Systemic Inflammation ◽

Quantitative Estimation ◽

Rehabilitation Program ◽

Inflammatory Biomarkers ◽

Inflammatory Activity ◽

Low Grade ◽

Positive Effects ◽

Inflammatory Profile

AbstractBackground and aimsRecent research indicates a previously unknown low-grade systemic or neurogenic inflammation in groups of chronic pain (CP) patients. Low-grade inflammation may have an important role in symptoms that have previously not been well depicted: widespread pain, tiredness and cognitive dysfunctions frequently seen in severely impaired CP patients. This study aimed to investigate the plasma inflammatory profile in a group of very complex CP patients at baseline and at a 1-year follow-up after participation in a cognitive behavior therapy (CBT)-based multimodal pain rehabilitation program (PRP).MethodsBlood samples were collected from 52 well-characterized CP patients. Age- and sex-matched healthy blood donors served as controls. The samples were analyzed with a multiple Proximal Extension Analysis allowing a simultaneous analysis of 92 inflammation-related proteins consisting mainly of cytokines, chemokines and growth-factors. At follow-up, 1-year after participation in the RPR samples from 28 patients were analyzed. The results were confirmed by a multi-array technology that allows quantitative estimation.ResultsClear signs of increased inflammatory activity were detected in the CP patients. Accepting a false discovery rate (FDR) of 5%, there were significant differences in 43/92 inflammatory biomarkers compared with the controls. In three biomarkers (CXCL5, SIRT2, AXIN1) the expression levels were elevated more than eight times. One year after the PRP, with the patients serving as their own controls, a significant decrease in overall inflammatory activity was found.ConclusionsOur results indicate that the most impaired CP patients suffer from low-grade chronic systemic inflammation not described earlier with this level of detail. The results may have implications for a better understanding of the cluster of co-morbid symptoms described as the “sickness-syndrome” and the wide-spread pain seen in this group of patients. The decrease in inflammatory biomarkers noted at the follow-up after participation in the PRP may reflect the positive effects obtained on somatic and psycho-social mechanisms involved in the inflammatory process by a rehabilitation program. Besides the PRP, no major changes in medication or lifestyle factors were implemented during the same period. To our knowledge, this is the first study reporting that a PRP may induce inflammatory-reducing effects. Further studies are needed to verify the objective findings in CP patients and address the question of causality that remains to be solved.ImplicationsThe findings offer a new insight into the complicated biological processes underlying CP. It may have implications for the understanding of symptoms collectively described as the “sickness-syndrome” – frequently seen in this group of patients. The lowering of cytokines after the participation in a PRP indicate a new way to evaluate this treatment; by measuring inflammatory biomarkers.

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Multidisciplinary treatment of chronic pain patients-a one year follow up study

Pain ◽

10.1016/0304-3959(90)92806-2 ◽

1990 ◽

Vol 41 ◽

pp. S345 ◽

Cited By ~ 1

Author(s):

M.F. Winnem ◽

L. Hauglin

Keyword(s):

Chronic Pain ◽

Multidisciplinary Treatment ◽

Follow Up Study ◽

Chronic Pain Patients ◽

One Year ◽

Pain Patients

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A one-year follow-up of chronic pain patients treated in an outpatient behavioral program

Pain ◽

10.1016/0304-3959(84)90752-8 ◽

1984 ◽

Vol 18 ◽

pp. S421

Author(s):

B. S. Gottlieb ◽

J. F. Brodey ◽

T. S. Sewitch ◽

M. B. Shaw ◽

L. L. Weiner

Keyword(s):

Chronic Pain ◽

Behavioral Program ◽

Chronic Pain Patients ◽

One Year ◽

Pain Patients

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Cost-effectiveness of adding psychomotor therapy to a multidisciplinary rehabilitation program for chronic pain

Global & Regional Health Technology Assessment Italian Northern Europe and Spanish ◽

10.33393/grhta.2020.2031 ◽

2020 ◽

Vol 7 (1) ◽

pp. 124-130

Author(s):

Lia Van der Maas ◽

Judith E. Bosmans ◽

Maurits W. Van Tulder ◽

Thomas W.J. Janssen

Keyword(s):

Chronic Pain ◽

Cost Effectiveness ◽

Cost Effective ◽

Rehabilitation Program ◽

Small Sample ◽

Mean Difference ◽

Data Uncertainty ◽

Life Years ◽

Chronic Pain Patients ◽

Pain Patients

Introduction: This study assesses the cost-effectiveness (CE) of a multidisciplinary pain rehabilitation program (treatment as usual [TAU]) with and without psychomotor therapy (PMT) for chronic pain patients. Methods: Chronic pain patients were assigned to TAU + PMT or TAU using cluster randomization. Clinical outcomes measured were health-related quality of life (HRQOL), pain-related disability, and quality-adjusted life years (QALYs). Costs were measured from a societal perspective. Multiple imputation was used for missing data. Uncertainty surrounding incremental CE ratios was estimated using bootstrapping and presented in CE planes and CE acceptability curves. Results: Ninety-four chronic pain patients (n = 49 TAU + PMT and n = 45 TAU) were included. There were no significant differences in HRQOL, Pain Disability Index, and QALYs between TAU + PMT and TAU. Direct costs in TAU + PMT were significantly higher than in TAU (mean difference €3327, 95% confidence interval [CI] 1329; 5506). However, total societal costs in TAU + PMT were not significantly higher than in TAU (mean difference €642, 95% CI −3323; 4373). CE analyses showed that TAU + PMT was not cost-effective in comparison with TAU. Conclusions: Adding PMT to a multidisciplinary pain rehabilitation program is not considered cost-effective in comparison with a multidisciplinary pain rehabilitation program alone. The results of this study should be interpreted with caution because of the small sample size and high drop-out rate.

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Cost–benefit of a 13-week multidiciplinary rehabilitation course for chronic non-malignant pain patients

Scandinavian Journal of Pain ◽

10.1016/j.sjpain.2010.05.019 ◽

2010 ◽

Vol 1 (3) ◽

pp. 173-173

Author(s):

Villy Meineche-Schmidt

Keyword(s):

Chronic Pain ◽

Sick Leave ◽

Cost Benefit ◽

Cost Effective ◽

Social Benefit ◽

Rehabilitation Program ◽

Transfer Income ◽

Pain Patients ◽

Observation Period

Abstract Background Economy is an important part of chronic pain. Aim To describe the economy in chronic non-malignant pain patients attending a 13-week Rehabilitation Program (RP). Methods All patients participating in the RP 2006–2008 were evaluated at baseline (BL) and at follow-up (FU) after an observation period of mean … month in relation to: (1) work-income (WI) or (2) transfer income (TI), comprised by: (a) sick-leave (SL), (b) sick pension (SP), (c) social benefit (SB) and (d) rehabilitation benefit (RB). The economic impact on state and county and the time to age pension was calculated. Results 117 patients attended the RP. At BL 23 patients had WI and 19 maintained this at FU (3 were on SP and 1 on RB). 90 patients were on TI at BL: 58 on SL at BL changed to 20 on SP + 23 on WI + 6 on SB + 1 on RB + 6 maintained SL, 12 on SB at BL changed to 6 on WI+ 1 on SP + 5 still on SB. 7 on RB at BL changed to 6 on WI + 1 on RB. The economic situation was concluded for 97 patients (83%). State expenses were increased by 540,000 Euro and county savings was 698,000 Euro. The societal savings were 158,000 Euro. The total costs for the RP was 421,000 Euro. Costs balanced savings after 2.7 years. The average time to age pension for the participating patients was 25 years. The potential accumulated savings thus amounted to 3.5 million Euros. Conclusions The 13-week Rehabilitation Program was highly cost effective: expenses for the program balanced savings after 3 years and the time to age pension for the participating patients was 25 years. The potential accumulated saving per patient was 30,000 Euro.

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