Basal Pain Sensitivity does not Predict the Outcome of Multidisciplinary Chronic Pain Treatment

Abstract

Results show that basal pain sensitivity is not a reliable predictor of treatment outcome in mixed diagnosis multidisciplinary pain management programs, possibly due to the heterogeneity of patients enrolled in such programs. Clinically useful predictors of treatment success in this setting remain to be identified.

Long-Term Outcomes of a Multimodal Day-Clinic Treatment for Chronic Pain under the Conditions of Routine Care

“…The reduction of depressive symptoms at the end of the treatment ( d =0.53) was comparable to some previous studies (e.g., Pieh et al [ 24 ]: d =0.54; Hampel et al [ 21 ]: d =0.57; Ruscheweyh et al [ 26 ]: d =0.42) but smaller than that observed by Borys et al [ 17 ] ( d =0.77), Moradi et al [ 22 ] ( d =0.7), and Pöhlmann et al [ 25 ] ( d =0.80). In contrast to Borys et al [ 17 ], Hampel et al [ 21 ], and Ruscheweyh et al [ 26 ] who reported that depression rates at follow-up (twelve months and six months, resp.) were no longer different from pretreatment, the reduction in symptoms of depression was significant at twelve-month follow-up in the current study ( d =0.38).…”

“…The patients' pain intensity improved from pre- to posttreatment with a medium effect size of d =0.59. This is comparable to the medium effect sizes of d =0.64 found by Hampel et al [ 21 ], d =0.6 reported by Moradi et al [ 22 ], and d =0.51 found by Ruscheweyh et al [ 26 ]. However, Pieh et al [ 24 ] and Pöhlmann et al [ 25 ] reported larger effect sizes of d =1.0 and d =0.69 − 0.98, respectively, concerning the reduction of the pain intensity at the end of a 5-week multimodal day-clinic treatment for patients with chronic pain.…”

“…The effect size for depression at 6-month follow-up ( d =0.45), however, was lower than the effect sizes reported by Moradi et al [22] and Pöhlmann et al [25] (both d =0.7). Compared with Schütze et al [ 27 ] ( d =0.10–0.20) and Ruscheweyh et al [ 26 ] ( d =0.26), the improvement at posttreatment regarding symptoms of anxiety represents a slightly higher effect ( d =0.40). Compared to Borys et al [ 17 ] ( d =0.55), however, the effect on anxiety at discharge was lower.…”

“…With regard to Schütze et al [ 27 ], the effect size at the six-month follow-up is comparable ( d =0.54 versus d =0.55), whereas the twelve-month follow-up effect size is smaller in the current study ( d =0.62 versus d =0.95 for 20% of the patients taking part in the follow-up in [ 27 ]). While Moradi et al [ 22 ] ( d = 0.7) and Pöhlmann et al [ 25 ] (0.69 − 0.98) reported higher effect sizes at 6-month follow-up Ruscheweyh et al [ 26 ] found a smaller long-term effect of d =0.33 at that time as did Hampel et al [ 21 ] ( d =0.37). The effect size for pain intensity at 12-month follow-up in the current study ( d =0.62) was higher than the one found by Borys et al [ 17 ] ( d =0.20).…”

“…When interpreting these benchmark comparisons, it is important to consider the following aspects as possible reasons for discrepant results. Different treatment durations (4 weeks in the present study and, e.g., in [ 26 ] versus 5 weeks in [ 24 , 25 ]), different treatment settings (e.g., day-clinic treatment in the present study and, e.g., in [ 24 , 25 ] versus inpatient treatment in [ 17 ]), and different dropout rates (e.g., 80% [ 27 ] or 59% [ 17 ] dropout at 1-year follow-up versus <50% dropout at 1-year follow-up in the present study).…”