Clinical and Demographic Predictors of Interdisciplinary Chronic Pain Rehabilitation Program Treatment Response

ORCID Identifiers

0000-0002-4314-2282

Document Type

Article

Source of Publication

Journal of Pain

Publication Date

12-1-2019

Abstract

© 2019 the American Pain Society Patients treated in interdisciplinary chronic pain rehabilitation programs show long-term improvements in symptoms; however, outcomes may vary across heterogenous patient subpopulations. This longitudinal retrospective study characterizes the influence of opioids, mood, patient characteristics, and baseline symptoms on pain and functional impairment (FI) in 1,681 patients 6-months to 12-months post-treatment in an interdisciplinary chronic pain rehabilitation program incorporating opioid weaning. Linear mixed models showed immediate and durable treatment benefits with nonuniform worsening at follow up which slowed over time. Latent class growth analysis identified three post-treatment trajectories of pain and FI: mild symptoms and durable benefits, moderate symptoms and durable benefits, and intractable symptoms. A fourth pain trajectory showed immediate post-treatment improvement and worsening at follow up. Whether a patient was weaned from opioids was not predictive of treatment trajectory. Racial ethnic minority status, higher levels of post-treatment depression, and lower perceived treatment response were associated with less resolution (moderate symptoms) or intractable symptoms. Not having a college education was predictive of intractable or worsening pain and a moderate course of FI. Older age and male gender was associated with intractable FI. Treatment outcomes may be improved by the development of targeted interventions for patients at risk of poor recovery and/or deteriorating long-term course. Perspective: This study examined predictors of treatment response in 1,681 patients treated in an interdisciplinary chronic pain rehabilitation program incorporating opioid weaning. Opioid weaning did not predict outcome. Higher levels of symptoms, lower levels of education, and being a racial-ethnic minority were associated with a less salubrious long-term treatment response.

ISSN

1526-5900

Publisher

Churchill Livingstone Inc.

Volume

20

Issue

12

First Page

1470

Last Page

1485

Disciplines

Education | Medicine and Health Sciences | Psychology | Social and Behavioral Sciences

Keywords

Chronic noncancer pain, health disparities, interdisciplinary chronic pain rehabilitation, latent class growth analysis, opioid use

Scopus ID

85069580373

Indexed in Scopus

yes

Open Access

no

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