Restricted accessResearch articleFirst published online 1996-9
Should Multidisciplinary Pain Management Programmes Attempt to Reduce Self-Reported Pain in Patients with Chronic Back Pain? The Experience of a Welsh Inpatient Unit
Given poor outcomes in pain reduction, It has recently been recommended in this Journal that the primary aim of multidisciplinary pain management programmes should be to improve physical functioning rather than attempting to reduce the experience of pain. This study evaluates the effectiveness of a pain management programme in reducing self-reported pain within the overall context of improvements in quality of life, as assessed by the SF36 Health Survey Questionnaire. Logistical and methodological problems in evaluating self-reported pain are discussed.
The results at discharge show a statistically significant reduction in reported pain for the group as a whole and a clinically relevant Improvement in 53.8% of patients. These benefits are maintained up to one-year follow-up, which suggests that pain management programmes should not abandon the attempt to reduce self-reported pain.
Get full access to this article
View all access options for this article.
References
1.
BlockARKremerEFGaylorM, (1980) Behavioural treatment of chronic pain: The spouse as a discriminative cue for pain behaviour. Pain, 9, 243–52.
2.
BrazierJEHarperRJonesNMB, (1992) Validating the SF36 health survey questionnaire: New outcome measure for primary care. British Medical Journal, 305,160–64.
3.
CleelandCS, (1989) Measurement of pain by subjective report. In: ChapmanCRLoeserJD, eds. Issues in pain measurement. Advances in Pain Research and Therapy, Vol. 12. New York: Raven Press, 391–403.
4.
FernandezETurkDC, (1989) The utility of cognitive coping strategies for altering pain perception: A meta-analysis. Pain, 38, 123–35.
5.
FischRWeaklandJHSegalL, (1982) The tactics of change: Doing therapy briefly. Los Angeles. Jossey-Bass.
6.
FisherK, (1988) Early experiences of a multidisciplinary pain management programme. Holistic Medicine, 3, 47–56.
7.
FordyceWE, (1978) Learning processes in pain. In: SternbachRA, ed. The psychology of pain. New York: Raven Press.
8.
FordyceWERobertsAHSternbachRA, (1985) The behavioural management of chronic pain: A response to critics. Pain, 22, 113–25.
9.
FlorHFydrichTTurkDC, (1992) Efficacy of multidisciplinary pain treatment centres: A meta-analytic review. Pain, 49, 221–30.
10.
GarrattAMRutaDAAbdallaMIBuckinghamJKRussellIT, (1993) The SF36 health survey questionnaire: An outcome measure suitable for routine use within the NHS?British Medical Journal, 306, 440–44.
11.
GarrattAMRutaDAAbdallaMIRussellIT, (1994) SF36 health survey questionnaire: II. Responsiveness to changes in health status in four common clinical conditions. Quality in Health Care, 3, 186–92.
12.
GhadialiEJ, (1995) Can a psychologist help a low back pain loser?Abstracts of a Scientific Meeting held in honour of Sampson Lipton. Liverpool: Pain Research Institute.
13.
GilesGMAllenME, (1986) Occupational therapy in the treatment of the patient with chronic pain. British Journal of Occupational Therapy, 49(1), 4–9.
14.
JacobsonNSTruaxP, (1991) Clinical significance: A statistical approach to defining meaningful change in psychotherapy research. Journal of Consulting and Clinical Psychology, 59, 12–19.
15.
JenkinsonCCoulterAWrightL, (1993) Short form 36 (SF36) health survey questionnaire: Normative data for adults of working age. British Medical Journal, 306, 1437–40.
16.
JenkinsonCWrightLCoulterA, (1994) Criterion validity and reliability of the SF36 in a population sample. Quality of Life Research, 3, 7–12.
17.
JensenMPTurnerJARomanoJM, (1994) Correlates of improvement in multidisciplinary treatment of chronic pain. Journal of Consulting and Clinical Psychology, 62, 172–79.
18.
KremerEFBlockAAtkinsonJH, (1983) Assessment of pain behaviour: Factors that distort self report. In: MelzackR, ed. Pain measurement and assessment. New York: Raven Press.
19.
McCormackGL, (1988) Pain management by occupational therapists. American Journal of Occupational Therapy, 42(9), 582–90.
20.
MoranMStrongJ, (1995) Outcomes of a rehabilitation programme for patients with chronic back pain. British Journal of Occupational Therapy, 58(10), 435–37.
NovyDMNelsonDVFrancisDJTurkDC, (1995) Perspectives of chronic pain: An evaluative comparison of restrictive and comprehensive models. Psychological Bulletin, 118(2), 238–47.
23.
PetersJLargeRGElkindG, (1992) Follow-up results from a randomised controlled trial evaluating in- and outpatient pain management programmes. Pain, 50, 41–50.
24.
RachlinH, (1985) Pain and behaviour. Behavioural and Brain Sciences, 8, 43–53.
25.
RobertsAHReinhardtL, (1980) The behavioural management of chronic pain: Long-term follow-up with comparison groups. Pain, 8, 151–62.
26.
RutaDAAbdallaMIGarrattAMCouttsARussellIT, (1994) SF36 health survey questionnaire: I. Reliability in two patient-based studies. Quality in Health Care, 3, 180–85.
27.
SkinnerJBErskineAPearceS, (1990) The evaluation of a cognitive behavioural treatment programme in outpatients with chronic pain. Journal of Psychosomatic Research, 34(1), 13–19.
28.
StewartALWareJE, (1992) Measuring functioning and well being: The medical outcome study approach. London: Duke University Press.
29.
SturgisETSchaeferCASikoraTL, (1984) Pain centre follow up of treated and untreated patients. Archives of Physical Medicine and Rehabilitation, 65, 301–303.
30.
TarlovARWareJEGreenfieldSNelsonECPerrinEZubkoffM, (1989) The medical outcomes study: An application of methods for monitoring the results of medical care. Journal of the American Medical Association, 262, 925–30.
31.
Tota-FaucetteMEGilKMWilliamsDAKeefeFJVeeraindarG, (1993) Predictions of response to pain management treatment. The role of family environment and changes in cognitive processes. Clinical Journal of Pain, 9, 115–23.
WilliamsACNicholasMKRichardsonPH, (1993) Evaluation of a cognitive behavioural programme for rehabilitating patients with chronic pain. British Journal of General Practice, 43, 513–18.
