Pain management strategies and team approach

Keel, Peter

doi:10.1053/berh.1999.0040

Cited by 26 publications

(16 citation statements)

References 28 publications

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“…Multidisciplinary treatment programs are recommended in patients with FM and CWP and the associated problems [5,6]. The multidisciplinary treatment is multimodal and often includes the efforts of a number of disciplines.…”

Section: Introductionmentioning

confidence: 99%

Predictors of outcome of multidisciplinary treatment in chronic widespread pain: an observational study

Rooij

Leeden

Roorda

et al. 2013

BMC Musculoskelet Disord

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BackgroundThe effectiveness of multidisciplinary treatment in chronic widespread pain (CWP) is limited. The considerable heterogeneity among patients is a likely explanation. Knowledge on predictors of the outcome of multidisciplinary treatment can help to optimize treatment effectiveness. The purpose of this study was to identify predictors of multidisciplinary treatment outcome in patients with CWP.MethodsData were used from baseline and 6 months follow-up measurements of a prospective cohort study of 120 CWP. Regression models were used to assess whether baseline variables predicted treatment outcome. Outcome domains included: pain, pain interference, depression, and global perceived effect (GPE). Potential predictors included: psychological distress, illness and self-efficacy beliefs, fear-avoidance beliefs and behaviour, symptoms, disability, and socio-demographic factors.ResultsGreater improvement in pain was predicted by more pain at baseline and male gender. Greater improvement in interference of pain in daily life was predicted by more interference of pain in daily life at baseline, lower levels of anxiety, a stronger belief in personal control, less belief in consequences, male gender, and a higher level of education. Greater improvement in depression was predicted by higher baseline values of depression, stronger beliefs in personal control, and a higher level of education. Better outcome on GPE was predicted by less pain, less fatigue, and a higher level of education.ConclusionLess anxiety, stronger beliefs in personal control, less belief in consequences, less pain, less fatigue, higher level of education, and male gender are predictors of better outcome of multidisciplinary treatment in CWP. Tailoring treatment to these specific patient characteristics or selecting eligible patients for multidisciplinary treatment may further improve treatment outcome.

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Section: Introductionmentioning

confidence: 99%

Predictors of outcome of multidisciplinary treatment in chronic widespread pain: an observational study

Rooij

Leeden

Roorda

et al. 2013

BMC Musculoskelet Disord

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“…It is important to discover through cognitive behavioural talks how environmental or personal factors exercise positive or negative influence of coping. These observations are an important basis for applying self-help strategies and stress management (Keel 1999). Men with CWP did not benefit from any of the multidisciplinary programs, and especially not the light model.…”

Section: Discussion Of Study IIImentioning

confidence: 79%

Different outcomes in subgroups of patients with long-term musculoskeletal pain

Skouen

Kvåle²

2009

Nor J Epidemiol

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Former studies have questioned the effectiveness of multidisciplinary rehabilitation for working-age adults with musculoskeletal pain problems. The lack of analysis within subgroups may explain why an effect of treatment of long-term musculoskeletal pain was not documented in former studies. In this article three later studies on long-term musculoskeletal pain patients are presented. The challenge of these studies was to identify subgroups of patients who benefit from different types of treatments. This article present the main findings of a large RCT with up till 54 months of follow-up among 664 persons sicklisted for musculoskeletal pain. It was hypothesised that different categories of patients need different treatment programs in order to get back to work. Patients with different prognoses for return to work were identified by means of a screening instrument, and it was tested whether those with poor prognosis need more extensive multidisciplinary treatment, compared to patients with less psychosocial and physical problems. Also, the effect of different treatment programs among patients with different diagnoses (ICD-9, low back pain and chronic widespread pain) and among men and women was examined. The results of the three studies support the authors' hypothesis that different categories of patients need different treatment programs. A higher percentage of return to work was demonstrated when the right treatment was given to the right patient, and considerable cost effectiveness was demonstrated.

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“…Physicians and patients should be educated about current theories regarding the underlying pathophysiologic mechanisms of FM, and then set realistic goals for all modalities of treatment. However, it is not possible to draw definite conclusions concerning the best approach to managing FM because results of randomized clinical trials present methodological limitations, and therapeutic programs are consistently heterogeneous, which renders them difficult to compare (7,8). However, a variety of pharmacological treatments, including analgesics, antidepressants, antiepileptics and many other drugs have been used to treat symptoms of FM with mixed results (8).…”

Section: Il Trattamento Farmacologico Della Sindrome Fibromialgica (Fmentioning

confidence: 99%

“…NSAIDs, which are commonly used for arthritic conditions, may be less effective for FM because pain associated with FM is not caused by muscle or joint inflammation. There is no scientific evidence that NSAIDs are effective when used alone in FM patients, although they may be useful adjuncts for analgesia when combined with tricyclic medications (1); the combination of NSAIDs with benzodiazepines, however, gave inconsistent results (1,(7)(8)(9). The central nervous system (CNS) mechanisms for the disorder, specifically, central sensitization, central disinhibition and a dysfunctional hypothalamic-pituitary-adrenal axis, could justify the relatively reduced efficacy of NSAIDs and opioids, the latter being more effective for "peripheral" pain (7).…”

Section: Analgesicsmentioning

confidence: 99%