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)

Abstract

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.

Wrist-Worn Activity Trackers in Laboratory and Free-Living Settings for Patients With Chronic Pain: Criterion Validity Study

“…Our sample included 76% women (31/41), which is in line with other studies describing people with chronic pain in Sweden [ 65 , 66 ] and other countries [ 67 ]. Patients in our sample had lived with pain for a shorter time than what is described in other studies of this population [ 68 , 69 ], and they rated their pain severity at baseline as equal to what have been reported in another study [ 70 ] describing patients participating in primary care management of low back pain patients. In our study, 37% of participants reported an exercise level of >90 minutes/week and 49% reported being physically active >150 minutes/week.…”

Spreading of Pain in Patients with Chronic Pain is Related to Pain Duration and Clinical Presentation and Weakly Associated with Outcomes of Interdisciplinary Pain Rehabilitation: A Cohort Study from the Swedish Quality Registry for Pain Rehabilitation (SQRP)

“…We have previously reported that the combination of gender, education level and country of birth are important for clinical presentation and treatment outcome. 19 Here we show that spreading of pain, used as a background variable in SQRP, is also important for understanding chronic pain, most clearly as an indicator of severity but also to some extent as a predictor of poor outcome of IMMRPs. The association between WSP and pain duration supports the concept of early intervention as clinically important and an opportunity to possibly change prognosis with conceivable gains for the individual and society.…”

“…29,73 A recent study showed that a combination of background variables (sex, education level and country of birth) could be used to explain participation rates in IMMRPs in SQRP. 19 Although there was a statistically significant difference indicating that patients with more widespread pain participated in IMMRPs less frequently, this difference was very small and was only present in comparison with the two intermediate number of pain sites groups. These findings contrast with findings from a smaller SQRP study that included patients from two clinical university hospital departments (n=1226) which showed that more spatial spreading of pain was positively associated with participation in IMMRPs.…”

“…Another recent study from the SQRP project found that patients born outside of Europe (including both men and women with different education levels) had the most severe clinical presentation at baseline while European women with a university education had the least severe clinical presentations at baseline. 19 Moreover, using the MIS outcome, it was found that IMMRPs benefited the latter more than the former subgroup. 19 The spatial distribution of pain (ie the spreading of pain over the body) differs among chronic pain patients.…”

“…19 Moreover, using the MIS outcome, it was found that IMMRPs benefited the latter more than the former subgroup. 19 The spatial distribution of pain (ie the spreading of pain over the body) differs among chronic pain patients. Chronic pain has been considered a continuum with widespread pain (WSP, including fibromyalgia) as one of the extremes which is associated with a more severe clinical picture and a worse prognosis.…”