Evaluating the Immediate Effectiveness of an Outpatient Pain Management Programme on Pain Related Interference: Outcomes from a Discrete Island-Based Chronic Pain Population.
This Research Poster was presented at the International Association for the Study of Pain (IASP) conference, Milan, 2012. Jersey is part of the British Isles and has an independent Healthcare System. The Island offers co-ordinated, complexity-stratified, unidisciplinary and intensive multidisciplinary pain management packages to the local adult population through a ‘funnel-neck’ pathway. This aims to cater for different needs and complexities of persistent pain sufferers. In order to respond to local needs and to maximise the available resources, a 7-day Pain Management Programme (PMP), spread over four weeks, is offered only to the more complex and psychosocially disabled clients. The aim of this study was to explore and quantify the differential impact on the change observed in pain-related interference, following attendance to an intensive 7-day PMP.
Methods: Data was obtained from a continuous sample (N=72) of patients attending the PMP at the beginning and end of treatment. Differences in scores between baseline and end of the PMP were computed utilising SPSS for all outcome measures. These included the Chronic Pain Acceptance Questionnaire (CPAQ), the Beck Depression Inventory – Fast Screen (BDI-FS), The Tampa Scale for Kinesiophobia (TSK), The Pain Self Efficacy Questionnaire (PSEQ), the Pain Catastrophising Scale (PCS) and the Brief Pain Inventory (BPI).
T-tests and direct multiple regression analyses were performed; difference in BPI interference used as the dependent outcome variable and the differences between scores on all the other measures used as independent variables.
Results: There was a statistically significant difference in pain interference, self-efficacy, two specific chronic pain acceptance domains (‘activity engagement’ and ‘pain willingness’), depression, kinesiophobia and catastrophising scores respectively, post intervention (t 6.46, df 72, p ≤.000; t -4.25, df 71, p ≤.000; t > -4.15, df 68, p ≤.000 t -3.69, df 68, p ≤.000; t 4.10, df 65, p ≤.000; > t 5.78 df 71, p ≤.000; t 6.85 df 71, p ≤.000) in the directions expected. Multiple regression using these characteristics produced an adjusted R2 of 0.35 (F = 4.83, p =.001) for the prediction of change in interference, with BDI and P-SEQ contributing most to the variance explained within the model.
Conclusions: Participants reported statistically significant changes between baseline and end of treatment on all measures. Depression and self-efficacy seem to be of much greater predictive value and significance, in terms of changes in pain interference. The initial conclusion is therefore that, one of the main goals of treatment, for this island-based population, should be to target explicitly mood and confidence. However, the findings are considered further in the context of the literature and in light of the idiosyncrasies, pathway, challenges and the natural evolution of the Pain Management Service in question. Additional potential mediators and confounders of the observed changes are discussed.