Impact of emotional distress and pain-related fear on patients with chronic pain: Subgroup analysis of patients referred to multimodal rehabilitation

Svanberg, Mikael; Stålnacke, Britt-Marie; Enthoven, Paul; Brodda-Jansen, Gunilla; Gerdle, Björn; Boersma, Katja

doi:10.2340/16501977-2212

Cited by 16 publications

(19 citation statements)

References 29 publications

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“…Groups 1 and 2 were the two extremes (together 45% of the cohort) and similar results have been presented earlier [ 63 , 64 ]. Group 1 presented a relatively good situation concerning pain characteristics, common comorbidities, and health aspects.…”

Section: Discussionsupporting

confidence: 86%

“…Group 2 was characterized by high psychological strain and high pain intensity. This constellation of psychological symptoms and pain was associated with low health and suffering as demonstrated earlier [ 14 , 64 – 70 ]. Patients in group 2 perceived their situation as being “worse than death” (i.e., negative figures) at group level per the EQ5D-Index.…”

Section: Discussionsupporting

confidence: 62%

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Chronic pain patients can be classified into four groups: Clustering-based discriminant analysis of psychometric data from 4665 patients referred to a multidisciplinary pain centre (a SQRP study)

et al. 2018

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ObjectiveTo subgroup chronic pain patients using psychometric data and regress the variables most responsible for subgroup discrimination.DesignCross-sectional, registry-based study.Setting and subjectsChronic pain patients assessed at a multidisciplinary pain centre between 2008 and 2015.MethodsData from the Swedish quality registry for pain rehabilitation (SQRP) were retrieved and analysed by principal component analysis, hierarchical clustering analysis, and partial least squares–discriminant analysis.ResultsFour subgroups were identified. Group 1 was characterized by low “psychological strain”, the best relative situation concerning pain characteristics (intensity and spreading), the lowest frequency of fibromyalgia, as well as by a slightly older age. Group 2 was characterized by high “psychological strain” and by the most negative situation with respect to pain characteristics (intensity and spreading). Group 3 was characterized by high “social distress”, the longest pain durations, and a statistically higher frequency of females. The frequency of three neuropathic pain conditions was generally lower in this group. Group 4 was characterized by high psychological strain, low “social distress”, and high pain intensity.ConclusionsThe identification of these four clusters of chronic pain patients could be useful for the development of personalized rehabilitation programs. For example, the identification of a subgroup characterized mainly by high perceived “social distress” raises the question of how to best design interventions for such patients. Differentiating between clinically important subgroups and comparing how these subgroups respond to interventions is arguably an important area for further research.

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Section: Discussionsupporting

confidence: 86%

Section: Discussionsupporting

confidence: 62%

Chronic pain patients can be classified into four groups: Clustering-based discriminant analysis of psychometric data from 4665 patients referred to a multidisciplinary pain centre (a SQRP study)

et al. 2018

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“…Women are overrepresented in specialist clinics in Sweden compared to the community prevalence and this selection is increased when analyzing the proportion who participated in IMMRP [26,27]. Hence, in the present study, 76.3% of the patients registered in SQRP were women.…”

Section: Sex Aspectsmentioning

confidence: 64%

“…Between 2008 and 2016, women compared to the community prevalence were overrepresented in Swedish specialist clinics. This overrepresentation is further increased with respect to participation in IMMRPs [26,27]. There are other demographic factors aside from sex that are important to consider.…”

Section: Introductionmentioning

confidence: 98%

Influences of Sex, Education, and Country of Birth on Clinical Presentations and Overall Outcomes of Interdisciplinary Pain Rehabilitation in Chronic Pain Patients: A Cohort Study from the Swedish Quality Registry for Pain Rehabilitation (SQRP)

Gerdle

Boersma

Åsenlöf

et al. 2020

JCM

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This study investigates the effects of sex, education, and country of birth on clinical presentations and outcomes of interdisciplinary multimodal pain rehabilitation programs (IMMRPs). A multivariate improvement score (MIS) and two retrospective estimations of changes in pain and ability to handle life situations were used as the three overall outcomes of IMMRPs. The study population consisted of chronic pain patients within specialist care in the Swedish Quality Registry for Pain Rehabilitation (SQRP) between 2008 and 2016 at baseline (n = 39,916), and for the subset participating in IMMRPs (n = 14,666). A cluster analysis based on sex, education, and country of origin revealed significant differences in the following aspects: best baseline clinical situation was for European women with university educations and the worst baseline clinical situation was for all patients born outside Europe of both sexes and different educations (i.e., moderate-large effect sizes). In addition, European women with university educations also had the most favorable overall outcomes in response to IMMRPs (small effect sizes). These results raise important questions concerning fairness and equality and need to be considered when optimizing assessments and content and delivery of IMMRPs for patients with chronic pain.

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“…Existing studies commonly suffer from lack of power due to small sample sizes, while, on the other hand, systematic reviews with meta-analyses are hampered by large study heterogeneity (8,9,13,14). Several factors have been reported to be associated with, and impact on, the prognosis of treatment effects of IMPR, reflecting a biopsychosocial panorama: pain and interference with everyday life, psychological distress, as well as sociodemographic characteristics (9,(13)(14)(15)(16)(17)(18). However, the relative importance of these factors require further validation in studies with large and clinically representative samples.…”

mentioning

confidence: 99%

Prognostic factors for improved physical and emotional functioning one year after interdisciplinary rehabilitation in patients with chronic pain: Results from a national quality registry in Sweden

Tseli¹,

Vixner²,

LoMartire³

et al. 2020

J Rehabil Med

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Chronic pain is a common condition that negatively affects most areas of a persons' life and is difficult to alleviate. Research indicates that interdisciplinary multimodal pain rehabilitation is effective in improving physical and emotional functioning, but little is known about the prognostic factors for a good treatment outcome. Therefore, this study investigated how different patient characteristics related to these outcomes, by following 2,876 patients across Sweden over a 1-year period. It was found that patients who were either currently working or on short-term sick leave clearly had a better prognosis in both outcomes than those with a longer time off from work. In addition, positive treat ment expectations, levels of emotional health, and coping strategies played an important role, but were not consistent for both outcomes, suggesting a complex prognostic picture for the overall understanding of improvement. These results emphasize the importance of early intervention before patients are too distanced from the labour market. Objective: To investigate prognostic factors for physical and emotional functioning following interdisciplinary multimodal pain rehabilitation, by targeting patients' baseline characteristics and health measures. Methods: A prospective cohort of 2,876 patients from 38 specialist clinics across Sweden, who were completing interdisciplinary multimodal pain rehabilitation programmes, was followed through the Swedish Quality Registry for Pain Rehabilitation, from initial assessment to 12-month follow-up. Using logistic regression, baseline data were regressed to predict improvement in Physical functioning and Emotional functioning, derived from principal component analyses of the 36-item Short Form Health Survey (SF-36) and the Hospital Anxiety and Depression Scale (HADS). Results: Employment status emerged as having the largest effect sizes in both Physical functioning and Emotional functioning; Working: odds ratio (OR) 2.05 (95% confidence interval (95% CI) 1.64-2.56) and OR 1.59 (95% CI 1.27-1.98), respectively. Strong beliefs in restored health, better initial emotional health, lower levels of pain and pain interference, and younger age all predicted Physical functioning. European origin, higher levels of general activity, and sense of life control all predicted Emotional func tioning. Worse initial physical and emotional health predicted the corresponding dependent outcomes. Conclusion: Employment was consistently found to be an important prognostic factor, suggesting the significance of avoiding delay in interdisciplinary multimodal pain rehabilitation. A positive treatment expectancy was of importance. In general, multidimensional measures indicated that better initial status was more favourable; however, inconsistency implies a complex prognostic picture.

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Impact of emotional distress and pain-related fear on patients with chronic pain: Subgroup analysis of patients referred to multimodal rehabilitation

Cited by 16 publications

References 29 publications

Chronic pain patients can be classified into four groups: Clustering-based discriminant analysis of psychometric data from 4665 patients referred to a multidisciplinary pain centre (a SQRP study)

Chronic pain patients can be classified into four groups: Clustering-based discriminant analysis of psychometric data from 4665 patients referred to a multidisciplinary pain centre (a SQRP study)

Influences of Sex, Education, and Country of Birth on Clinical Presentations and Overall Outcomes of Interdisciplinary Pain Rehabilitation in Chronic Pain Patients: A Cohort Study from the Swedish Quality Registry for Pain Rehabilitation (SQRP)

Prognostic factors for improved physical and emotional functioning one year after interdisciplinary rehabilitation in patients with chronic pain: Results from a national quality registry in Sweden

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