Improved health-related quality of life, participation, and autonomy in patients with treatment-resistant chronic pain after an intensive social cognitive intervention with the participation of support partners

Abstract

Despite the availability of various specific treatments, most patients with chronic pain (CP) consider their pain problem as undertreated. Recently, multiple sclerosis (MS) patients who were given an intensive 3-day social cognitive treatment with the participation of support partners experienced lasting improvements in health-related quality of life (HRQoL) and self-efficacy. In this study, a similar intervention was given to treatment-resistant CP patients with stressors, relational problems with support partner, and distress, anxiety or depression. Before and 1, 3, and 6 months after the intervention, patients completed the Euro-Qol 5 Dimensions 5 Levels (EQ-5D-5L) and Impact on Participation and Autonomy (IPA) questionnaires (primary outcomes), and the Survey Of Pain Attitudes (SOPA), the Four-Dimensional Symptom Questionnaire (4DSQ) (distress, depression, anxiety, and somatization), and Visual Analog Scale for pain intensity, whereas the support partners completed the Caregiver Strain Index (CSI) questionnaire. Differences between baseline and post-treatment were tested via paired t-tests (significance level 0.05). Of the 39 patients who were included, 34 (87.2%) completed the 3-day treatment. At 1, 3, and 6 months, improvements were seen in EQ-5D-5L-Index (+40.6%; +22.4%; +31.7%), Health Today (+61.8%; +36.3%; +46.8%), Control attitude (+45.8%; not significant [NS]; +55.0%) and decreases in IPA-Problems (−14.8%; NS; −20.4%), Harm attitude (−18.9%; −15.0%; −17.7%), Distress (−17.7%; −31.8%; −37.1%), and Depression (−37.4%; −31.4%; −35.7%) scores. The CSI score had decreased by −29.0%, −21.4%, and −25.9%, respectively. In conclusion, after an intensive 3-day social cognitive intervention, treatment-resistant CP patients experienced substantial and lasting improvements in HRQoL and in problematic limitations to participation and autonomy, in association with improvements in pain attitudes, depression, and distress. To assess whether this innovative approach may be an effective treatment for this subgroup of CP patients, future randomized controlled studies are needed.

Effect of an intensive 3-day social cognitive treatment (can do treatment) on control self-efficacy in patients with relapsing remitting multiple sclerosis and low disability: A single-centre randomized controlled trial

“…An unmasked RCT assessed the effect of CDT, an intensive 3-day multidisciplinary social cognitive theory-based treatment, on control self-efficacy in low-disability RRMS patients and found no difference compared with waitlist controls who had the option to receive the intervention after study participation.We think that the CDT concept may be further developed, e.g. by selecting patients with evident points of interaction, such as stressors, high levels of distress or relational problems with (support) partner [24], and by applying out-patients settings or web-based applications.…”

Model development to improve primary care services using an innovative network of homecare providers (WinCare) to promote blood pressure control among elderly patients with noncommunicable diseases in Thailand: a prospective cohort study

“…This study was permitted to use the EQ-5D-5L questionnaires by the EuroQol Research Foundation (ID Number 28208). The EQ-5D-5L defines health in terms of five dimensions: 1) mobility, 2) self-care, 3) usual activities, 4) pain/discomfort and 5) anxiety/depression [ 15 , 16 ]. Each dimension has five levels including extreme, severe, moderate, slight and no problem [ 15 , 17 ].…”

An economic evaluation attached to a single-centre, parallel group, unmasked, randomized controlled trial of a 3-day intensive social cognitive treatment (can do treatment) in patients with relapsing remitting multiple sclerosis and low disability

“…in one observational study, a similar intervention was successful in patients with intractable chronic pain 32 . In addition, the effects of CDT may be expected to be generalizable to other (western) societies, as is suggested in the study by Ng et al 57 on a similar intervention in American patients with MS. 7.…”

“…In the first two SUAs [SUA1 and SUA2] only patients showing a clinically meaningful increase in MSSES Control at 6 months were selected (75 or more points); in two other SUAs [SUA3 and SUA4], the 50% of the patients with the lowest MSSES Control scores at baseline were selected. The selection of the other four SUAs was based on a recent report of an intense social cognitive intervention in patients with treatment-resistant chronic pain 32 ; patients were included in this study if they reported (1) relational problems with their support partner, (2) stressors, and (3) distress, depression, or anxiety. Sub-groups of patients were obtained by selecting those who experienced all three factors [SUA6 and SUA8], and those having depressive or anxious symptoms [SUA5 and SUA7].…”