A Network Analysis of Clinical Variables in Chronic Pain: A Study from the Swedish Quality Registry for Pain Rehabilitation (SQRP)

Abstract

Background Efforts to identify specific variables that impact most on outcomes from interdisciplinary pain rehabilitation are challenged by the complexity of chronic pain. Methods to manage this complexity are needed. The purpose of the study was to determine the network structure entailed in a set of self-reported variables, examine change, and look at potential predictors of outcome, from a network perspective. Methods In this study we apply network analysis to a large sample of people seeking interdisciplinary pain treatment (N = 2,241). Variables analyzed include pain intensity, pain interference, extent of pain, depression, anxiety, insomnia, and psychological variables from cognitive behavioral models of chronic pain. Results We found that Acceptance, Pain Interference, and Depression were key, “central,” variables in the pretreatment network. Interestingly, there were few changes in the overall network configuration following treatment, specifically with respect to which variables appear most central relative to each other. On the other hand, Catastrophizing, Depression, Anxiety, and Pain Interference each became less central over time. Changes in Life Control, Acceptance, and Anxiety were most strongly related to changes in the remainder of the network as a whole. Finally, no network differences were found between treatment responders and non-responders. Conclusions This study highlights potential future targets for pain treatment. Further application of a network approach to interdisciplinary pain rehabilitation data is recommended. Going forward, it may be better to next do this in a more comprehensive theoretically guided fashion, and ideographically, to detect unique individual differences in potential treatment processes.

Identifying goals in patients with chronic pain: A European survey

“…Due to the complexity of chronic pain, several variables influence the outcome of an interdisciplinary pain rehabilitation. A recent network analysis revealed acceptance, pain interference, anxiety, catastrophizing and depression as the most central variables in both pre-and post-treatment networks (Akerblom et al, 2021). A previous study demonstrated that the actual content of multidisciplinary pain centre clinical assessments, according to the ICF Low Back Pain Core set, provides multidisciplinary teams a universal language to support assessments across disciplines (Bagraith et al, 2018).…”

Perspective Chapter: Interdisciplinary Pain Rehabilitation Programs – Evidence and Clinical Real-World Results

“…Hence, it is important to assess insomnia in patients with complex chronic pain. A network analysis (N = 2 241) reported that psychological variables, such as acceptance and depression mainly were associated with pain interference, whereas the associations with pain intensity and extent together with insomnia were weak [78]. These results taken together may be important for expectations about treatment results (i.e., improvements in psychological distress may not necessarily lead to important improvements in pain intensity).…”

Internet-Delivered Acceptance and Commitment Therapy Added to Multimodal Pain Rehabilitation: A Cluster Randomized Controlled Trial

“…Pain acceptance has been questioned as an outcome measure as it also possesses the features of a process measure and has been described as a moderator. A significant change in pain acceptance (CPAQ-8 short form) with medium effect size was however seen in association with other pain outcome measures in a network analysis, indicating that acceptance may be directly affected by rehabilitation and hence constitute an outcome measure by itself [57].…”