Evaluation of the effectiveness of a chronic pain management programme

Abstract

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An evaluation of support groups for patients with long-term chronic pain and complex psychosocial difficulties

“…Although the benefits are not clearly found in results from standardized measures of functional disability (RMDQ-A) and mood (HADS), they are suggested by progress through the pain stages of change (PSOCQ), good and active attendance despite significant physical handicaps, feedback from the weekly questionnaires, staff observation of groups' progress and the development of local self-help support groups advocating for pain patients. It was disappointing that, since treatment effect sizes are greatest for mood in pain management programmes (Collins et al, 1998) no similar improvement was found: although anxiety scores did reduce, they only approached significance ( p < 0.09) (Table I). However, this may reflect the more rigorous selection of patients described earlier for specialist programmes (Turk & Rudy, 1990 that is not representative of the chronic pain population found in this sample.…”

“…When comparing the results obtained here with traditional pain management programmes, which typically obtain 50-60 per cent 'improvement' (Flor et al, 1992) particularly in mood and activity level (Collins et al, 1998), the results of this study are not so powerful. What has to be born in mind is that this patient group experienced a complex of problems, with long-term illness and disability, mental health problems, motivational difficulties, medical dependency, poor financial and employment opportunities and social isolation.…”

“…However, although changes in subjective indices of pain levels are expected in traditional pain management programmes (Gough & Frost, 1996) they are not necessarily always found (e.g. Collins et al, 1998;Johansson, Dahl, Jannert, Melin, & Andersson, 1998). There is also a suggestion that relief of pain appears to contribute only partially to overall satisfaction with pain management (Stahmer, Shofer, Marino, Shepherd, & Abbuhl, 1998).…”

“…The effects of these physical symptoms are to contribute disproportionately to the total score and, because they are chronic, they maintain higher levels of anxiety and depression. Nevertheless treatment effect sizes in pain management programmes are among the highest for measures of mood (Collins, Carr, & O'Keefe, 1998).…”