Clinical effectiveness of an interdisciplinary pain management programme compared with standard inpatient rehabilitation in chronic pain: a naturalistic, prospective controlled cohort study.

摘要

OBJECTIVE: To compare the effects of an interdisciplinary pain management programme with those of standard in-patient rehabilitation by comprehensive biopsychosocial self--assessment. METHODS: In this naturalistic prospective controlled cohort study, 164 chronic pain patients who participated in the interdisciplinary pain programme and 143 who underwent standard rehabilitation were assessed using standardized instruments. Effect differences were compared bivariately and analysed by multivariate logistic regression to control for baseline differences in the outcome variables and confounders. RESULTS: On entry into the clinic, the interdisciplinary pain programme patients were younger and showed significantly worse mental and psychosocial health than the standard rehabilitation patients. At discharge, the interdisciplinary pain programme patients reported greater improvement on pain (multivariate p = 0.034), social functioning (bivariate p = 0.009), and in trend in catastrophizing and ability to decrease pain. At the 6-month follow-up, the effects experienced by the standard rehabilitation group were higher on physical functioning, social functioning, anxiety, and life control (multivariate p = 0.013-0.050). CONCLUSION: Intensive interdisciplinary rehabilitation with more behavioural therapies was accompanied by a greater improvement in patients who were severely affected by pain, compared with standard rehabilitation by the end of the stay, but not in the mid-term. Highly resource-consuming patients may benefit from subsequent, individually tailored outpatient care.