scholarly journals Insomnia Symptoms and Chronic Pain among Patients Participating in a Pain Rehabilitation Program—A Registry Study

2021 ◽  
Vol 10 (18) ◽  
pp. 4040
Author(s):  
Josefine Lind ◽  
Paulin Andréll ◽  
Anna Grimby-Ekman
Keyword(s):  
Chronic Pain ◽  
Physical Function ◽  
Well Being ◽  
Social Function ◽  
Rehabilitation Program ◽  
Future Research ◽  
Chronic Pain Patients ◽  
Mental Well Being ◽  
Pain Patients ◽  
Insomnia Symptoms

Insomnia and chronic pain are prevalent health complaints. Previous research has shown that they are closely associated, but their interaction and causality are not completely understood. Further research is needed to uncover the extent to which a treatment strategy focusing on one of the conditions affects the other. This study aimed to map the prevalence of insomnia symptoms among patients in interdisciplinary pain rehabilitation program (IPRP) and investigate associations between the degree of insomnia at baseline and the treatment outcome regarding pain intensity, physical function, social function, mental well-being, anxiety, and depression. Of the 8515 patients with chronic pain, aged 15–81 who were registered in the Swedish Quality Registry for Pain Rehabilitation during 2016–2019 and participated in IPRP, 7261 had follow-up data after treatment. Logistic regression analysis was used to investigate associations. The prevalence of clinical insomnia, according to Insomnia Severity Index (ISI), among chronic pain patients in IPRP was 66%, and insomnia symptoms were associated with both country of birth and educational level. After IPRP, the prevalence of clinical insomnia decreased to 47%. There were statistically significant associations between the degree of insomnia symptoms before IPRP and physical function (p < 0.001), social function (p = 0.004) and mental well-being (p < 0.001). A higher degree of insomnia symptoms at baseline was associated with improvement after IPRP. In conclusion, IPRP seem to have beneficial effects on insomnia symptoms in chronic pain patients. Nevertheless, almost half of the patients still suffer from clinical insomnia after IPRP. The possible effect of systematic screening and treatment of insomnia for improving the effect of IPRP on pain is an important area for future research.

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

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.

scholarly journals Happy despite pain: Pilot study of a positive psychology intervention for patients with chronic pain

2015 ◽  
Vol 7 (1) ◽  
pp. 71-79 ◽  
Author(s):  
Ida K. Flink ◽  
Elke Smeets ◽  
Sofia Bergboma ◽  
Madelon L. Peters
Keyword(s):  
Chronic Pain ◽  
Pilot Study ◽  
Positive Psychology ◽  
Emotional Problems ◽  
Well Being ◽  
Controlled Study ◽  
Reliable Change ◽  
Positive Psychology Intervention ◽  
Chronic Pain Patients ◽  
Pain Patients

AbstractBackground and purposeDealing with chronic pain is difficult and affects physiological as well as psychological well-being. Patients with chronic pain are often reporting concurrent emotional problems such as low mood and depressive symptoms. Considering this, treatments need to involve strategies for improving mood and promoting well-being in this group of patients. With the rise of the positive psychology movement, relatively simple intervention strategies to increase positive feelings, cognitions, and behaviours have become available. So far, the evidence for positive psychology techniques mainly comes from studies with healthy participants, and from studies with patients expressing emotional problems such as depression or anxiety as their main complaint. This study describes an initial attempt to explore the potential effects of a positive psychology intervention in a small sample of patients suffering from chronic pain.MethodsA replicated single case design was employed with five participants. The participants started to fill out daily self-reports and weekly questionnaires two weeks before the intervention started, and continued throughout the intervention. In addition, they filled out a battery of questionnaires at pretest, posttest, and at a three months follow-up. The instruments for assessment were selected to cover areas and constructs which are important for pain problems in general (e.g. disability, life satisfaction, central psychological factors) as well as more specific constructs from positive psychology (e.g. compassion, savoring beliefs).ResultsThe results on pre and post assessments showed an effect on some of the measures. However, according to a more objective measure of reliable change (Reliable Change Index, RCI), the effects were quite modest. On the weekly measures, there was a trend towards improvements for three of the participants, whereas the other two basically did not show any improvement. The daily ratings were rather difficult to interpret because of their large variability, both between and within individuals. For the group of participants as a whole, the largest improvements were on measures of disability and catastrophizing.ConclusionsThe results of this preliminary study indicate that a positive psychology intervention may have beneficial effects for some chronic pain patients. Although it is not to be expected that a limited positive psychology intervention on its own is sufficient to treat pain-related disability in chronic patients, our findings suggest that for some it may be an advantageous complement to enhance the effects of other interventions.ImplicationsThe results of this pilot study about the potential effects of a positive psychology intervention for chronic pain patients may be encouraging, warranting a larger randomized controlled study. Future studies may also concentrate on integrating positive psychology techniques into existing treatments, such as composite CBT-programs for chronic pain patients. Our advice is that positive psychology interventions are not to be regarded as stand-alone treatments for this group of patients, but may potentially enhance the effect of other interventions. However, when and for which patients these techniques may be recommended is to be explored in future research.

Pilot study of eDOL, a new mHealth application and web platform for medical follow-up of chronic pain patients (Preprint)

2021 ◽  
Author(s):  
NICOLAS KERCKHOVE ◽  
Noémie Delage ◽  
Sébastien Cambier ◽  
Nathalie Cantagrel ◽  
Eric Serra ◽  
...  
Keyword(s):  
Chronic Pain ◽  
Pain Management ◽  
Real Life ◽  
Basic Research ◽  
High Rate ◽  
Future Research ◽  
Chronic Pain Patients ◽  
Pain Patients

BACKGROUND The pharmacopoeia of analgesics is old, their effectiveness is limited, with undesirable effects and little progress has been made in recent years. Thus, innovation is limited despite prolific basic research. Better characterization of patients could help to identify the predictors of successful treatments through research programs, and therefore enable physicians to carry out better decision-making in the initial choice of treatment and in the follow-up of their patients. Nevertheless, the current assessment of chronic pain patients provides only fragmentary data on their painful daily experiences. Thus, it is essential to modify the temporality in which patients’ sensations are assessed, with real-life monitoring of different parameters, i.e. subjective and objective markers of chronic pain. Consequently, recent studies have highlighted the urgent need to develop self-management and chronic pain management programs through e-health programs, and enhance their therapeutic value. OBJECTIVE We hypothesize that regular patient self-monitoring using an mHealth application would lead physicians to obtain deeper knowledge and a new vision of chronic pain patients, while for patients it would play a positive therapeutic role, as they become active in their own management and benefit from online advice. Such an assessment would not only contribute to better patient characterization and help in the choice of the most appropriate treatment, but could also improve adherence to treatment. To address this issue, we evaluated the feasibility and acceptability, by patients and physicians, of a new mHealth application called eDOL. METHODS An observational study assessing the feasibility and acceptability of the eDOL tool was conducted. Patients completed several questionnaires via eDOL over a period of 2 weeks, and then repeatedly over a period of 3 months. Physicians saw their patients at a follow-up visit that took place at least 3-months after the inclusion visit. The primary endpoint, a composite criterion reflecting the acceptability of eDOL and the feasibility of its use, was assessed using satisfaction questionnaires for both patients and physicians after the completion of study. RESULTS One hundred and thirty-three patients were included of whom 105 were analyzable. Our results showed a rate of adherence of approximately 60% of patients after 3 months of using eDOL, a median acceptability score around 7/10 for both patients and physicians, a high rate of completion of the baseline questionnaires / meters, and a low rate for follow-up questionnaires / meters and forms. We were also able to characterize subgroups of patients and determine a profile of those who adhered to eDOL. CONCLUSIONS This work demonstrates that eDOL is highly feasible and acceptable for both chronic pain patients and their physicians. It also shows that such a tool can integrate many parameters to ensure the detailed characterization of patients for future research works and pain management. CLINICALTRIAL NCT03931694

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

2017 ◽  
Vol 16 (1) ◽  
pp. 175-176
Author(s):  
E.-B. Hysing ◽  
L. Smith ◽  
M. Thulin ◽  
R. Karlsten ◽  
T. Gordh
Keyword(s):  
Chronic Pain ◽  
Systemic Inflammation ◽  
Rehabilitation Program ◽  
Inflammatory Activity ◽  
Low Grade ◽  
Inflammatory Biomarker ◽  
Chronic Pain Patients ◽  
One Year ◽  
Pain Patients

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.

scholarly journals Do Chronic Pain Patients Wish Spiritual Aspects to Be Integrated in Their Medical Treatment? A Cross-Sectional Study of Multiple Facilities

2021 ◽  
Vol 12 ◽  
Author(s):  
Karin Hasenfratz ◽  
Hanspeter Moergeli ◽  
Haiko Sprott ◽  
André Ljutow ◽  
René Hefti ◽  
...  
Keyword(s):  
Chronic Pain ◽  
Depression Scale ◽  
Well Being ◽  
Cross Sectional Study ◽  
Patient Centered ◽  
Cross Sectional ◽  
Chronic Pain Patients ◽  
Spiritual Well Being ◽  
Spiritual Resources ◽  
Pain Patients

Background: Chronic pain is a complex, multidimensional experience. Spirituality is hypothesized to impact pain experience in various ways. Nevertheless, the role that spirituality plays in multimodal pain therapy remains controversial and, to date, quantitative data on whether and for which patients spiritual aspects should be considered in the treatment of chronic pain is lacking. The aim of this study was thus to investigate the proportion and characteristics of patients with chronic pain who wish spiritual aspects to be integrated in their treatment.Methods: Two hundred nine patients with chronic pain were recruited from five inpatient departments and outpatient clinics in the German-speaking part of Switzerland. Patients filled out validated questionnaires, such as the Hospital Anxiety and Depression Scale (HADS), the Resilience Scale (RS-11), the Spiritual and Religious Attitudes in Dealing with Illness (SpREUK), and the 12-item Spiritual Well-Being Scale (FACIT-Sp-12).Results: More than 60% (CI95%: 55.5–67.9%) of the patients wanted to address spiritual aspects in their treatment. These patients were significantly younger, had higher levels of education, and suffered from more frequent and more severe pain than patients who did not wish to address spiritual aspects. Furthermore, there were high correlations with existing spiritual resources and higher scores of spirituality.Conclusions: These results confirm that the majority of chronic pain patients wish spiritual aspects to be considered in their treatment. Additionally, the finding that these patients had more spiritual resources underlines the importance of integrating spiritual aspects in a resource-oriented, patient-centered care approach for this condition.

Does validation and alliance during the multimodal investigation affect patients’ acceptance of chronic pain? An experimental single case study

2019 ◽  
Vol 19 (1) ◽  
pp. 73-82 ◽  
Author(s):  
Mikael Svanberg ◽  
Ann-Christin Johansson ◽  
Katja Boersma
Keyword(s):  
Chronic Pain ◽  
Therapeutic Effect ◽  
Pain Catastrophizing ◽  
Single Case ◽  
Rehabilitation Program ◽  
Self Report ◽  
Pain Coping ◽  
Chronic Pain Patients ◽  
Before And After ◽  
Pain Patients

Abstract Background and aims Among chronic pain patients who are referred to participation in a multimodal rehabilitation program (MMRP), pain catastrophizing and dysfunctional pain coping is common. In many cases it may have driven the patient to a range of unsuccessful searches for biomedical explanations and pain relief. Often these efforts have left patients feeling disappointed, hopeless and misunderstood. The MMRP process can be preceded by a multimodal investigation (MMI) where an important effort is to validate the patient to create a good alliance and begin a process of change towards acceptance of the pain. However, whether the MMI has such therapeutic effect is unclear. Using a repeated single case experimental design, the purpose of this study was to investigate the therapeutic effect of MMI by studying changes in patients’ experience of validation, alliance, acceptance of pain, coping, catastrophizing, and depression before and during the MMI process. Methods Participants were six chronic pain patients with high levels of pain catastrophizing (>25 on the Pain Catastrophizing Scale) and risk for long term disability (>105 on the Örebro Musculoskeletal Pain Screening Questionnaire) who were subjected to MMI before planned MMRP. For each patient, weekly self-report measures of validation, alliance and acceptance of pain were obtained during a 5–10-weeks baseline, before the MMI started. Subsequently, these measures were also obtained during a 6–8 weeks MMI process in order to enable comparative analyses. Additionally, pain coping, depression and pain catastrophizing were measured using standardized questionnaires before and after the MMI. Results Irrespective of experiences of validation and alliance before MMI, all six patients felt validated and experienced a good alliance during MMI. Acceptance of pain improved only in one patient during MMI. None of the patients showed clinically relevant improvement in pain coping, depression or catastrophizing after the MMI. Conclusions The patients did not change their acceptance and pain coping strategies despite of good alliance and experience of validation during the MMI process. Even if the design of this study precludes generalization to chronic pain patients in general, the results suggest that MMI may not have a therapeutic effect.

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