Evaluating Outcomes in the Interdisciplinary Treatment of Chronic Pain: A Guide for Practicing Clinicians

Abstract Objective Numerous studies support the effectiveness of Acceptance and Commitment Therapy (ACT) for chronic pain, yet little research has been conducted about its underlying mechanisms of change, especially regarding patients with comorbid mental disorders. The present investigation addressed this issue by examining associations of processes targeted by ACT (pain acceptance, mindfulness, psychological flexibility) and clinical outcomes (pain intensity, somatic symptoms, physical health, mental health, depression, general anxiety). Subjects Participants were 109 patients who attended an ACT-based interdisciplinary treatment program for chronic pain and comorbid mental disorders in a routine care psychiatric day hospital. Methods Pre- to post-treatment differences in processes and outcomes were examined with Wilcoxon signed-rank tests and effect size r. Associations between changes in processes and changes in outcomes were analyzed with correlation and multiple regression analyses. Results Pre- to post-treatment effect sizes were mostly moderate to large (r between |0.21| and |0.62|). Associations between changes in processes and changes in outcomes were moderate to large for both, bivariate correlations (r between |0.30| and |0.54|) and shared variances accounting for all three processes combined (R2 between 0.21 and 0.29). Conclusion The present investigation suggests that changes in pain acceptance, mindfulness and psychological flexibility are meaningfully associated with changes in clinical outcomes. It provides evidence on particular process-outcome associations that had not been investigated in this way before. The focus on comorbid mental disorders informs clinicians about a population of chronic pain patients that often has a severe course of illness and has seldom been studied.

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The Interdisciplinary Treatment Approach for Chronic Pain Management: The Key Components for Success

Handbooks in Health, Work, and Disability - Handbook of Musculoskeletal Pain and Disability Disorders in the Workplace ◽

10.1007/978-1-4939-0612-3_20 ◽

2014 ◽

pp. 365-377

Author(s):

Ben Lippe ◽

Peter B. Polatin

Keyword(s):

Chronic Pain ◽

Pain Management ◽

Treatment Approach ◽

Interdisciplinary Treatment ◽

Chronic Pain Management

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Early Changes in Pain Acceptance Predict Pain Outcomes in Interdisciplinary Treatment for Chronic Pain

Journal of Clinical Medicine ◽

10.3390/jcm8091373 ◽

2019 ◽

Vol 8 (9) ◽

pp. 1373 ◽

Cited By ~ 3

Author(s):

Probst ◽

Jank ◽

Dreyer ◽

Seel ◽

Wagner ◽

...

Keyword(s):

Chronic Pain ◽

Pain Intensity ◽

Pain Perception ◽

Rating Scale ◽

Post Treatment ◽

Interdisciplinary Treatment ◽

Binary Logistic Regression Analysis ◽

Pain Acceptance ◽

Pain Outcomes ◽

The Impact

Studies have shown that pain acceptance is associated with a better pain outcome. The current study explored whether changes in pain acceptance in the very early treatment phase of an interdisciplinary cognitive-behavioral therapy (CBT)-based treatment program for chronic pain predict pain outcomes. A total of 69 patients with chronic, non-malignant pain (at least 6 months) were treated in a day-clinic for four-weeks. Pain acceptance was measured with the Chronic Pain Acceptance Questionnaire (CPAQ), pain outcomes included pain intensity (Numeric Rating Scale, NRS) as well as affective and sensory pain perception (Pain Perception Scale, SES-A and SES-S). Regression analyses controlling for the pre-treatment values of the pain outcomes, age, and gender were performed. Early changes in pain acceptance predicted pain intensity at post-treatment measured with the NRS (B = −0.04 (SE = 0.02); T = −2.28; p = 0.026), affective pain perception at post-treatment assessed with the SES-A (B = −0.26 (SE = 0.10); T = −2.79; p = 0.007), and sensory pain perception at post-treatment measured with the SES-S (B = -0.19 (SE = 0.08); T = -2.44; p = 0.017) . Yet, a binary logistic regression analysis revealed that early changes in pain acceptance did not predict clinically relevant pre-post changes in pain intensity (at least 2 points on the NRS). Early changes in pain acceptance were associated with pain outcomes, however, the impact was beneath the threshold defined as clinically relevant.

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Online paediatric chronic pain management: assessing the needs of UK adolescents and parents, using a cross-sectional survey

British Journal of Pain ◽

10.1177/2049463720940341 ◽

2020 ◽

pp. 204946372094034

Author(s):

Anna Hurley-Wallace ◽

Daniel E Schoth ◽

Suzanne Lilley ◽

Glyn Williams ◽

Christina Liossi

Keyword(s):

Social Media ◽

Chronic Pain ◽

Pain Management ◽

Online Survey ◽

Interdisciplinary Treatment ◽

Future Research ◽

Chronic Pain Management ◽

Cross Sectional Survey ◽

Cross Sectional ◽

Social Media Platforms

Background: Adolescent chronic pain is prevalent, and interdisciplinary treatment is recommended. Although it is well known that technology is a key part of adolescents’ daily lives, there have not been any online, interdisciplinary interventions developed for adolescents with chronic pain in a UK healthcare context. Little is known about how adolescents currently use online resources to manage chronic pain, or what guidance they seek. Methods: Ninety-five participants from the community answered this mixed-methods, online survey (adolescent n = 54, parent n = 41), which assessed the needs of UK-based adolescents for a new online chronic pain management resource. Results: Findings indicated that, at the time of the survey, adolescents frequently used social media platforms, such as Instagram, for chronic pain management. Desired techniques for a new interdisciplinary resource for adolescents included ‘advice on explaining chronic pain to others’ (86.7% of adolescents) and sleep hygiene (82.2% of adolescents), though access to a range of pain management techniques was desired. Qualitative results indicated endorsement of a new programme by adolescents and parents. Conclusions: Adolescents and parents had a positive outlook towards the development of a UK-specific online resource to help manage chronic pain. Such an intervention should aim to be made accessible via the National Health Service. Adolescent use of social media platforms to seek support for chronic pain requires further exploration in future research.

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A Comparative Meta-Analysis of Unidisciplinary Psychology and Interdisciplinary Treatment Outcomes Following Acceptance and Commitment Therapy for Adults with Chronic Pain

Journal of Pain ◽

10.1016/j.jpain.2019.10.004 ◽

2020 ◽

Vol 21 (5-6) ◽

pp. 529-545 ◽

Cited By ~ 1

Author(s):

Kevin E. Vowles ◽

Melissa Pielech ◽

Karlyn A. Edwards ◽

Mindy L. McEntee ◽

Robert W. Bailey

Keyword(s):

Chronic Pain ◽

Treatment Outcomes ◽

Acceptance And Commitment Therapy ◽

Meta Analysis ◽

Interdisciplinary Treatment ◽

Commitment Therapy ◽

Acceptance And Commitment

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Interdisciplinary treatment of chronic pain

Current Review of Pain ◽

10.1007/s11916-000-0005-7 ◽

2000 ◽

Vol 4 (1) ◽

pp. 18-23 ◽

Cited By ~ 16

Author(s):

Margaret A. Gardea ◽

Robert J. Gatchel

Keyword(s):

Chronic Pain ◽

Interdisciplinary Treatment

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The Biopsychosocial Model of the Assessment, Prevention, and Treatment of Chronic Pain

US Neurology ◽

10.17925/usn.2016.12.02.98 ◽

2016 ◽

Vol 12 (02) ◽

pp. 98 ◽

Cited By ~ 19

Author(s):

Kelley Bevers ◽

Lynette Watts ◽

Nancy D Kishino ◽

Robert J Gatchel ◽

◽

...

Keyword(s):

Chronic Pain ◽

Pain Management ◽

Biopsychosocial Model ◽

Emotional Reactivity ◽

Functional Restoration ◽

Interdisciplinary Treatment ◽

Specific Patient ◽

Increased Risk ◽

Prevention And Treatment ◽

Pain Patients

The biopsychosocial model has been demonstrated to be the most heuristic approach to chronic pain assessment, prevention, and treatment. Currently, this model also provides the best foundation for tailoring the most comprehensive pain management program for each specific patient. Chronic pain patients have an increased risk for developing deficits in physical functioning, emotional reactivity, and cognition. Interdisciplinary treatment, based on the biopsychosocial model, is vital to address these multifaceted issues facing chronic pain sufferers. These interdisciplinary pain management strategies have progressed with advancements in science and technology in an attempt to provide the best possible outcomes for pain patients. However, while research has made enormous advances, there are still some clinical research gaps to be addressed. This article will begin with a historical overview of pain management in order to demonstrate the evolution in theory from ancient practices to the modern biopsychosocial model. Additionally, functional restoration and other early interdisciplinary intervention programs will be highlighted for their importance and effectiveness in chronic pain management, assessment, and prevention.

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