Clinical effectiveness of a pain psychology service within an outpatient secondary care setting

Abstract

Purpose – Data gathered from routine clinical settings is complementary to evidence garnered from controlled efficacy trials. The purpose of this paper is to present individual-level analysis of changes in a group of patients discharged from psychological therapy within an outpatient pain service. The service had recently shifted from a traditional cognitive-behavioural approach to one underpinned by Acceptance and Commitment Therapy. Design/methodology/approach – Reliable and clinically significant change methodology was applied to CORE-10 outcomes for 27 patients discharged during 2013-2014. Outcomes were compared to 2012-2013. A patient satisfaction questionnaire was administered and functional outcomes were collated. Findings – Outcomes were not adversely affected by the shift in service focus as clients demonstrating reliable improvement increased from 2012-2013; 81 per cent reliably improved, 44 per cent made a clinically significant improvement. Increases in returning to work/unpaid activities at post-treatment were noted. The service met a number of NICE quality standards concerning the “relational” aspects of care. Research limitations/implications – Clinical effectiveness is evaluated through one outcome measure thereby limiting conclusions. The longer term effectiveness of the service remains unclear. Narrow demographic information limits an assessment of any systematic biases in findings. Little is known about treatment drop-outs. Practical implications – A number of recommendations concerning data collection and future service evaluations are made. Social implications – Returning to paid or unpaid activities has a high public health impact. Originality/value – This paper contributes towards the evidence base for using psychological therapies with clients experiencing chronic pain and related distress. Importantly, the paper complements evidence for general efficacy (from large-scale controlled studies) through an evaluation of real-world effectiveness (i.e. practice-based evidence).

Brief cognitive analytic therapy for adults with chronic pain: a preliminary evaluation of treatment outcome

“…The improvements observed in the current evaluation compare well with other uncontrolled studies conducted in routine clinical settings in the United Kingdom. Sheldon et al 63 Penlington 64 reported a small to medium effect size ( . ) d = 0 36 for the Pain Self-Efficacy Scale (PSEQ) 65 following an 8-week, compassion-focused intervention.…”