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

Abstract

<jats:title>Abstract</jats:title> <jats:sec id="j_sjpain-2018-0051_s_999"> <jats:title id="d2482991e546">Background and aims</jats:title> <jats:p>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.</jats:p></jats:sec> <jats:sec id="j_sjpain-2018-0051_s_998"> <jats:title id="d2482991e554">Methods</jats:title> <jats:p>Participants were six chronic pain patients with high levels of pain catastrophizing (&gt;25 on the Pain Catastrophizing Scale) and risk for long term disability (&gt;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.</jats:p></jats:sec> <jats:sec id="j_sjpain-2018-0051_s_997"> <jats:title id="d2482991e562">Results</jats:title> <jats:p>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.</jats:p></jats:sec> <jats:sec id="j_sjpain-2018-0051_s_996"> <jats:title id="d2482991e570">Conclusions</jats:title> <jats:p>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.</jats:p></jats:sec>

Adolescent and Parent Experiences of Acceptance and Commitment Therapy for Pediatric Chronic Pain: An Interpretative Phenomenological Analysis

“…For adults with chronic pain, experiences of validation and invalidation in the communication with their physician seem to be of specific importance for patients with high pain interference and negative affectivity [64]. However, mere validation, alliance building and information about the biopsychosocial model had no significant effect on outcomes for adults with chronic pain [65]. In-depth analysis of the communication that takes place during ACT, for example, in conjunction with an observational study, like one that focused on the behaviors of parents of young people with chronic pain who were undergoing residential pain treatment [66], could shed further light on pain communication for young people, in their interaction with one another, as well as with their family and their treatment provider.…”

Opioid Prescriptions in Chronic Pain Rehabilitation. A Prospective Study on the Prevalence and Association between Individual Patient Characteristics and Opioids

“…IMMRPs are based on the biopsychosocial framework where the illness is understood as an interaction among biological, psychological and social factors [ 6 ]. IMMRPs are preceded by a multidisciplinary assessment that aims to assist in patient selection to the programs and development of a rehabilitation plan for those who will not participate, as well as to motivationally prepare the patient prior to IMMRP start [ 7 ]. This also includes an assessment and optimization of medication regimens which are thereafter held constant throughout program participation.…”