<p>Who benefits from multimodal rehabilitation &ndash; an exploration of pain, psychological distress, and life impacts in over 35,000 chronic pain patients identified in the Swedish Quality Registry for Pain Rehabilitation</p>

Abstract

BackgroundChronic pain patients frequently suffer from psychological symptoms. There is no consensus concerning the prevalence of severe anxiety and depressive symptoms and the strength of the associations between pain intensity and psychological distress. Although an important aspect of the clinical picture is understanding how the pain condition impacts life, little is known about the relative importance of pain and psychological symptoms for individual’s life impact. The aims of this study were to identify subgroups of pain patients; to analyze if pain, psychological distress, and life impact variables influence subgrouping; and to investigate how patients in the subgroups benefit from treatments.MethodsBackground variables, pain aspects (intensity/severity and spreading), psychological distress (depressive and anxiety symptoms), and two life impact variables (pain interference and perceived life control) were obtained from the Swedish Quality Registry for Pain Rehabilitation for chronic pain patients and analyzed mainly using advanced multivariate methods.ResultsBased on >35,000 patients, 35%–40% had severe anxiety or depressive symptoms. Severe psychological distress was associated with being born outside Europe (21%–24% vs 6%–8% in the category without psychological distress) and low education level (20.7%–20.8% vs 26%–27% in the category without psychological distress). Dose relationships existed between the two psychological distress variables and pain aspects, but the explained variances were generally low. Pain intensity/severity and the two psychological distress variables were significantly associated (R2=0.40–0.48; P>0.001) with the two life impact variables (pain interference and life control). Two subgroups of patients were identified at baseline (subgroup 1: n=15,901–16,119; subgroup 2: n=20,690–20,981) and the subgroup with the worst situation regarding all variables participated less in an MMRP (51% vs 58%, P<0.001) but showed the largest improvements in outcomes.ConclusionThe results emphasize the need to assess both pain and psychological distress and not take for granted that pain involves high psychological stress in the individual case. Not all patients benefit from MMRP. A better matching between common clinical pictures and the content of MMRPs may help improve results. We only partly found support for treatment resistance in patients with psychological distress burden.

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

“…Similar results have often been interpreted as an effect of regression to the mean, or to the circumstance that the worse your problem is on a certain measure the more likely it is that you may benefit from treatment on that same variable. Our results on this are in agreement with other recent prediction studies that also emanated from SQRP data, where a general pattern indicated that the largest improvements in levels of functioning and life impact of pain were associated with lower initial scores (15,16).…”

“…poor initial emotional health. This finding is in line with current evidence (15); however, 2 regressors emerged as favourable in this clinical picture; perceived life control and overall activity level, both of which indicated that "higher" levels were related to a good prognosis.…”

“…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.…”

Long-term outcomes of multimodal rehabilitation in primary care for patients with chronic pain

“…Although the present study was conducted during the period 2012-15, at that time MMRPs were still in the phase of implementation in primary care. Since MMRP was initiated as a new rehabilitation intervention, healthcare professionals from the primary healthcare units reported both negative and positive aspects when implementing it (33). They also experienced similar difficulties in managing work ability and return to work in MMRP, as reported from other primary care units in Sweden (37).…”

“…The teams play a central role in the coordination of MMRP. In a previous qualitative study, the importance of creating good teamwork was pointed out as a key factor for the implementation of MMRP in primary care (33). Although most studies of MMRP have been conducted in specialist care, a previous study from a primary care unit has shown promising long-term results regarding depression, social activity, physical activity and healthcare utilization after one year (34).…”