Evaluation of an interdisciplinary chronic pain program and predictors of readiness for change

Abstract

Background: One in five Canadians experience chronic pain, and interdisciplinary pain programs are well established as the gold standard of treatment. However, not all patients are ready to engage in interdisciplinary treatment for chronic pain. Aims: The aims of this study were to (1) first demonstrate changes in patient-related outcomes after attending a publicly funded 8-week interdisciplinary pain program and (2) evaluate painrelated predictors of readiness for change. Methods: The institution's research ethics board approved this study. One hundred twentynine patients completed questionnaires on the first and last day of attending the program. Paired sample t-tests were utilized to evaluate the changes in patient-related outcomes after attending the program, and linear regressions were utilized to evaluate pain-related predictors of the stages of change. Results: Postprogram, there were significant decreases in pain-related interference, fear of pain/re-injury, pain catastrophizing, and symptoms of stress, depression, and anxiety and a significant increase in wellness-focused coping and self-efficacy. Postprogram, patients also demonstrated lower scores in precontemplation and contemplation and higher scores in action and maintenance stages of readiness for change. In predicting precontemplation, fear of pain/re-injury was the sole predictor, and self-efficacy was the sole predictor of the contemplation, action, and maintenance stages. Conclusion: These results demonstrate the short-term benefits of an 8-week interdisciplinary pain program. It is suggested that preprogram interventions targeting kinesophobia for individuals who are precontemplative and self-efficacy for others may be important to facilitate patient engagement. RÉSUMÉContexte: Un Canadien sur cinq souffre de douleur chronique. Il est bien établi que les programmes interdisciplinaires de la douleur constituent le traitement de référence. Toutefois, ce ne sont pas tous les patients qui sont prêts à suivre un traitement interdisciplinaire pour la douleur chronique. Buts: Les buts de cette étude étaient : 1) démontrer les changements dans les résultats liés aux patients après que ces derniers aient participé à un programme interdisciplinaire de la douleur de huit semaines, financé par des fonds publics, et 2) évaluer les prédicteurs de la disposition au changement lié à la douleur. Méthodes: La commission d'éthique de la recherche de l'institution a approuvé cette étude. Cent vingt-neuf patients ont répondu à des questionnaires le premier et le dernier jour de leur participation au programme. Des tests T pour échantillons appariés ont été utilisés pour évaluer les changements dans les résultats liés aux patients après avoir participé au programme et des régressions linéaires ont été utilisées pour évaluer les prédicteurs des étapes du changement lié à la douleur. Résultats: Après le programme, des diminutions significatives ont été observées dans l'interférence liée à la douleur, la peur de la douleur ou d'une nouvelle blessure, la catastrophisat...

The development and efficacy of an interdisciplinary chronic pelvic pain program

“…Our initial sample also represented a relatively young group of women who have only recently been off work in comparison to other chronic pain programs. 17,20 Earlier intervention may lead to less persistent pain-related interference and disability, and this presents an opportunity to support this group of individuals learn coping strategies to better manage their pain, increase their functioning, and potentially get back to work and important life roles earlier on. An interesting line of future investigation would be to examine whether or not attending an interdisciplinary CPP program earlier on in the disease/surgical process would lead to better outcomes and less disability over time.…”

“…The Interdisciplinary CPP Program was developed as an adaptation from established and ongoing pain programs running at the Michael G. DeGroote Pain Clinic 17,20 focusing specifically on key factors identified from the literature based on the needs of women struggling to cope with CPP. The interdisciplinary team consisted of a psychologist, pelvic floor physiotherapist, pharmacist, dietician, occupational therapist, and social worker, all of which were female as many of the topics in this program were sensitive in nature.…”

Implementation of the Ottawa Hospital Pain Clinic stepped care program: A preliminary report

“… 7 This multidimensional model is often used to inform the treatment of chronic pain. 8 , 9 Multidisciplinary pain management using a biopsychosocial approach is considered the gold standard. 8 , 10 To be considered a multidisciplinary program, the program must be delivered with at least two different health care specialties, including medicine, nursing, psychology, social work, physiotherapy, and/or occupational therapy.…”

“… 8 , 9 Multidisciplinary pain management using a biopsychosocial approach is considered the gold standard. 8 , 10 To be considered a multidisciplinary program, the program must be delivered with at least two different health care specialties, including medicine, nursing, psychology, social work, physiotherapy, and/or occupational therapy. 11 , 12 The multidisciplinary pain management team members are often located within the same clinic, with frequent contact through team meetings to discuss unified goals and values for the program and for patients.…”

Effects of a pain management programme on occupational performance are influenced by gains in self-efficacy

“…It includes the confidence to cope with challenging situations, and the level of perseverance one may apply to seek solutions to their situation. Importantly, self-efficacy beliefs are not static and can change in response to experience and circumstance, and are thus an important modifiable target for pain management programmes (Katz et al., 2019).…”