Who benefits from multimodal rehabilitation – 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
Received 7 October 2018
Accepted for publication 3 January 2019
Published 7 March 2019 Volume 2019:12 Pages 891—908
Checked for plagiarism Yes
Review by Single-blind
Peer reviewers approved by Dr Colin Mak
Peer reviewer comments 4
Editor who approved publication: Dr Michael Ueberall
Björn Gerdle,1 Sophia Åkerblom,2,3 Gunilla Brodda Jansen,4 Paul Enthoven,1 Malin Ernberg,5,6 Huan-Ji Dong,1 Britt-Marie Stålnacke,7 Björn O Äng,8–10 Katja Boersma11
1Pain and Rehabilitation Centre, Department of Medical and Health Sciences, Linköping University, Linköping, Sweden; 2Department of Pain Rehabilitation, Skåne University Hospital, Lund, Sweden; 3Department of Psychology, Lund University, Lund, Sweden; 4Division of Rehabilitation Medicine, Department of Clinical Sciences, Danderyd Hospital, Stockholm, Sweden; 5Department of Dental Medicine, Karolinska Institutet, Huddinge, Sweden; 6Scandinavian Center for Orofacial Neuroscience (SCON), Huddinge, Sweden; 7Department of Community Medicine and Rehabilitation, Rehabilitation Medicine, Umeå University, Umeå, Sweden; 8Department of Neurobiology, Care Sciences and Society, Division of Physiotherapy, Karolinska Institutet, Huddinge, Sweden; 9Center for Clinical Research Dalarna – Uppsala University, Falun, Sweden; 10School of Education, Health and Social Studies, Dalarna University, Falun, Sweden; 11School of Law, Psychology and Social Work, Örebro University, Örebro, Sweden
Background: Chronic 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.
Methods: Background 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.
Results: Based 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.
Conclusion: The 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.
Keywords: anxiety, chronic pain, control, depression, life impact, sociodemographic
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