<p>Qualitative evaluation of an interdisciplinary chronic pain intervention: outcomes and barriers and facilitators to ongoing pain management</p>

Abstract

Background Many leaders in the field of chronic pain treatment consider interdisciplinary pain management programs to be the most effective treatments available for chronic pain. As programs are instituted and expanded to address demands for nonpharmacological chronic pain interventions, we need to better understand how patients experience program impacts, as well as the challenges and supports patients encounter in trying to maintain and build on intervention gains. Methods We conducted a qualitative evaluation of an interdisciplinary chronic pain coaching program at the Atlanta Veterans Affairs. A purposive sample of Veterans were engaged in interviews (n=41) and focus groups (n=20) to elicit patient outcomes and barriers and facilitators to sustainment of improvements. Transcripts were analyzed using matrix and thematic analyses. Results Veterans reported various outcomes. Most frequently they described adopting new self-care or lifestyle practices for pain management and health. They also often described accepting pain, being better able to adjust and set boundaries, feeling more in control, participating in life, and changing their medication use. A small portion of the sample reported no improvement in their conditions. When outcomes were examined as a whole, individuals described impacts that could be placed along a spectrum from whole life change to no change. Facilitators to maintenance of improvements included having building blocks (eg, carrying forward practices learned), support (eg, access to resources), and energy (eg, motivation), and improving incrementally. Challenges were not having building blocks (eg, life disruptions), support (eg, unknown follow-up options), and energy (eg, competing demands) and having an unbalanced rate of improvement. Conclusion Most Veterans identified experiencing multiple areas of improvement, especially learning about and taking up new pain and general health management skills. Ensuring participants can build on and find support for these outcomes when applying what they have learned in their dynamic social and physical worlds remains a challenge for this program and other relatively short-term interdisciplinary chronic pain interventions.

‘A lifebuoy’ and ‘a waste of time’: patients’ varying experiences of multidisciplinary pain centre treatment- a qualitative study

“…Substantially different experiences from multidisciplinary pain treatments have also been found by others. One study showed that the overall impact of an interdisciplinary chronic pain intervention programme could be placed along a spectrum from whole life change to no change [22], whereas another study used the labels ‘overall life changes’ and ‘stagnation’ [27] to describe different experiences of a multimodal cognitive chronic pain treatment.…”

“…A strength of the study is the novelty in the exploration of experiences of persons attending outpatient individual multidisciplinary pain treatment that was not part of inpatient, group based or time-limited programmes, as in e.g., [22, 29, 30]; however, there are some noteworthy limitations. The aim was to obtain data that represented the variations in patients’ experiences in Norwegian pain centres in order to answer the research question.…”

“…Those that have, showed that the learned techniques were useful even years after participation [20] and that patients perceived that the professionals empowered them to take responsibility for their daily lives, including their health [21]. Moreover, a recent qualitative evaluation of an interdisciplinary 10-week chronic pain programme showed that the spectrum of impact of the intervention ranged from whole life change to no change at all [22]. Notably, most studies have focussed on inpatient, group-based or time-limited multidisciplinary pain programmes.…”

Doctor Recommendations are Related to Patient Interest and Use of Behavioral Treatment for Chronic Pain and Addiction

“…Previous research suggests that patients typically benefit from interdisciplinary approaches to pain management, including lifestyle modification, movement therapies, and mind-body based treatments. 32 Patients' behavioral treatment preferences did not always exactly mirror doctor recommendations, and those who had received behavioral recommendations typically noted interest in several approaches, suggesting that there may be room for discussion of multiple approaches to pain management. Discussing these multiple approaches may ultimately increase receipt, as patients cite having a wide array of treatment options as a facilitator to using behavioral treatments for chronic pain.…”

The Importance of Perceived Relevance: A Qualitative Evaluation of Patient’s Perceptions of Value and Impact Following a Low-Intensity Group-Based Pain Management Program

“…Limited evidence exists exploring perceptions of which aspects of a pain management program are valuable and impactful, which could guide the implementation of service delivery and program redesign. Qualitative studies, which can achieve this purpose, have previously concentrated on other aspects including, but not limited to: patient values in the years following a high-intensity program [ 16 ], the patient’s perceived barriers and facilitators to self-management [ 17 , 18 , 19 ], the patient’s perceptions of themselves [ 20 ] and of changes that have occurred after a program [ 16 , 21 ], broader perceptions of pain treatments and life [ 22 ], navigating chronic pain healthcare systems [ 23 , 24 ], successful strategies used outside of a pain management program [ 25 ], perspectives on opioids [ 26 , 27 ], and patient’s expectations about a program [ 28 ]. Understanding more about participant perceptions could improve the acceptance of active evidence-based therapies like pain management programs [ 29 ].…”