Interdisciplinary treatment of chronic pain

Gardea, Margaret A.; Gatchel, Robert J.

doi:10.1007/s11916-000-0005-7

Cited by 29 publications

(19 citation statements)

References 19 publications

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“…Since there is often co-morbidity in chronic pain patients, Gatchel (2002Gatchel ( , 2004 strongly suggested treating depression and pain simultaneously, and in an interdisciplinary manner to attain positive and significant outcomes (Gardea & Gatchel, 2000). Turk and Okifuji (1998) suggested that all back pain patients should receive physical therapy, psychological support, and encouragement to target a full remission.…”

Section: Discussionmentioning

confidence: 99%

Pain and depression in injured workers and their return to work: A longitudinal study.

Corbière¹,

Sullivan²,

Stanish³

et al. 2007

Canadian Journal of Behavioural Science / Revue canadienne des

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This study investigated the long-term relationships between depression, pain, and return to work in injured workers with chronic pain. Clients (M = 185) completing the Pain Disability Prevention Program were evaluated for pain and depression at three points in time: on admission to the treatment program, at mid-treatment, and at the end of treatment. The return to work (RTW) was assessed at four weeks after the intervention ended. Correlation and logistic regression analyses showed that depression and pain were significantly associated over time, and that depression and affective pain were the most significant variables for predicting RTW regardless of the time of assessment. An initial cluster analysis divided the sample into four groups reflecting fluctuations of depression and pain over time. Chi-square results indicated that individuals with severe or moderate depression and high levels of affective pain were less likely to RTW (from 18% to 21%) compared to individuals with mild depression or normal emotional "ups and downs" and lower affective pain scores (from 61%. to 85%). These results highlighted the importance of considering the clinical symptoms profiles over time when determining the probability of RTW.In injured workers, a strong association has been previously identified between chronic pain and psychopathology (Dersh, reviewed the published literature, focusing on the association between pain and deptiession, and noted that some studies had design limitations (i.e., cross-sectional and not longitudinal). For instance, 21 studies in the review illustrated a significant relationship between the severity of perceived pain and the level of depression. However, only five longitudinal studies demonstrated that the extent or duration of pain could be linked to depression over time, making it unclear

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Section: Discussionmentioning

confidence: 99%

Pain and depression in injured workers and their return to work: A longitudinal study.

Corbière¹,

Sullivan²,

Stanish³

et al. 2007

Canadian Journal of Behavioural Science / Revue canadienne des

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“…There are clear and evidence-based methods for managing generic chronic pain in an interdisciplinary fashion of which a substantial proportion may be translatable into COFP [60,61]. A recent national pain audit [21] in the U.K. has, however, highlighted the difficulty in establishing the provision of such a service for generic chronic pain management nationwide, irrespective of the need for a condition specific service.…”

Section: Discussionmentioning

confidence: 99%

Developing Effective and Efficient care pathways in chronic Pain: DEEP study protocol

et al. 2014

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BackgroundPain affecting the face or mouth and lasting longer than three months (“chronic orofacial pain”, COFP) is relatively common in the UK. This study aims to describe and model current care pathways for COFP patients, identify areas where current pathways could be modified, and model whether these changes would improve outcomes for patients and use resources more efficiently.Methods/DesignThe study takes a prospective operations research approach. A cohort of primary and secondary care COFP patients (n = 240) will be recruited at differing stages of their care in order to follow and analyse their journey through care. The cohort will be followed for two years with data collected at baseline 6, 12, 18, and 24 months on: 1) experiences of the care pathway and its impacts; 2) quality of life; 3) pain; 4) use of health services and costs incurred; 5) illness perceptions. Qualitative in-depth interviews will be used to collect data on patient experiences from a purposive sub-sample of the total cohort (n = 30) at baseline, 12 and 24 months. Four separate appraisal groups (public, patient, clincian, service manager/commissioning) will then be given data from the pathway analysis and asked to determine their priority areas for change. The proposals from appraisal groups will inform an economic modelling exercise. Findings from the economic modelling will be presented as incremental costs, Quality Adjusted Life Years (QALYs), and the incremental cost per QALY gained. At the end of the modelling a series of recommendations for service change will be available for implementation or further trial if necessary.DiscussionThe recent white paper on health and the report from the NHS Forum identified chronic conditions as priority areas and whilst technology can improve outcomes, so can simple, appropriate and well-defined clinical care pathways. Understanding the opportunity cost related to care pathways benefits the wider NHS. This research develops a method to help design efficient systems built around one condition (COFP), but the principles should be applicable to a wide range of other chronic and long-term conditions.

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“…Long-term pain can be costly to treat and generates a significant burden on healthcare systems 1,3,4 . In particular, treatment of long-term pain requires an interdisciplinary approach, which can lead to high costs 5 . It is important to treat pain efficiently and as early as possible because there is less chance of a patient developing long-term pain if treated well in the early stages of acute pain.…”

Section: I a L D I S T R I B U T I O N U N A U T H O R I Z E D U S mentioning

confidence: 99%

Opioids: a two-faced Janus

Ahlbeck

2011

Current Medical Research and Opinion

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Background: Long-term pain is a debilitating condition that is costly to treat and has a significant impact on patient quality of life. Classical opioids have been used for the treatment of pain for centuries and are one of the most effective drug classes available for acute severe pain and long-term pain. However, concerns regarding adverse effects, tolerance to analgesic effects and the potential for addiction have resulted in a reluctance to prescribe and use opioids for the management of long-term non-cancer pain. Adverse events, including gastrointestinal side effects such as constipation, nausea and vomiting, and central nervous system side effects such as sedation are responsible for as many as one in five patients discontinuing opioid treatment, often leading to inadequate pain relief and poor patient quality of life. Therefore, new analgesic therapies are needed that are associated with fewer adverse effects, whilst providing sustainable pain relief for patients with long-term pain.

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Interdisciplinary treatment of chronic pain

Cited by 29 publications

References 19 publications

Pain and depression in injured workers and their return to work: A longitudinal study.

Pain and depression in injured workers and their return to work: A longitudinal study.

Developing Effective and Efficient care pathways in chronic Pain: DEEP study protocol

Opioids: a two-faced Janus

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