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Scandinavian Journal of Pain

Editor-in-Chief: Breivik, Harald

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Assessment and treatment at a pain clinic: A one-year follow-up of patients with chronic pain

Andrea Hållstam
  • Corresponding author
  • Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, and Unit of Anaesthesiology and Intensive Care, Södersjukhuset, SE-11883 Stockholm, Sweden
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/ Monika Löfgren
  • Department of Clinical Sciences, Karolinska Institutet, and Department of Rehabilitation Medicine, Danderyd Hospital, SE-18288 Stockholm, Sweden
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/ Lina Benson
  • Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, SE-11883 Stockholm, Sweden
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/ Christer Svensén
  • Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, and Unit of Anaesthesiology and Intensive Care, Södersjukhuset, SE-11883 Stockholm, Sweden
  • University of Texas Medical Branch at Galveston, UTMB Health, Department of Anaesthesiology, Galveston, TX, USA
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/ Britt-Marie Stålnacke
  • Department of Clinical Sciences, Karolinska Institutet, and Department of Rehabilitation Medicine, Danderyd Hospital, SE-18288 Stockholm, Sweden
  • Department of Community Medicine and Rehabilitation, Rehabilitation Medicine, Umeå University, SE-90185 Umeå, Sweden
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Published Online: 2017-12-29 | DOI: https://doi.org/10.1016/j.sjpain.2016.08.004

Abstract

Background and aims

Pain is one of the most common reasons for patients to seek primary health care. Pain relief is likely to be achieved for patients suffering from acute pain, but for individuals with chronic pain it is more likely that the condition will persist. These patients have the option of being referred to specialised pain clinics. However, the complexity surrounding chronic pain patients is not well studied in these settings. This study aimed to describe patients with chronic pain referred to a pain clinic by using the information submitted during their first visit and one year later and also to identify associations between baseline characteristics and improvements in health-related quality of life in the follow-up.

Methods

This was a longitudinal observational study of a sample consisting of 318 patients referred to a pain clinic. One group of patients containing 271 individuals (median age 48, 64% females) was assessed and received conventional pain treatment (CPT group) and a second group of 47 patients (median age 53, 64% females) was assessed by a pain specialist and referred back to their physician with a treatment recommendation (assessment only, AO group). Patient-reported outcome measures in health-related quality of life (EQ-5D), pain intensity (VAS), mental health (HADS), insomnia (ISI), pain-related disability (PDI), kinesiophobia (TSK) and sense of coherence (SOC) were collected at the first visit and one year later.

Results

At baseline, the CPT group reported a low EQ-5D Index (median (md) 0.157) and EQVAS (md 40) as well as considerable high, current pain intensity VAS (md 58), HADS anxiety (md 8), ISI (md 17), PDI (md 36) and TSK (md 39). The AO group showed similar problems (no significant differences compared to the CPT group), except for ISI, where the AO group reported less severe problems. At the one-year follow-up, the CPT group had a statistically significant improvement in EQ-5D, VAS, ISI, PDI and TSK. In the AO group no significant changes were observed. In the CPT group there was an association between a high ISI level at baseline and an improved EQ-5D Index in the follow-up.

Conclusions

The study describes rarely explored groups of patients with chronic pain at a pain clinic. Severe pain problems were present in both groups at their first visit. A statistically significant improvement could be seen in the group that was conventionally treated while this was not the case among those subjects who were assessed and referred. The results imply, that relatively limited treatment strategies were helpful for the patients’ health-related quality of life. Despite these improvements, the patients were not fully recovered, pointing to the chronicity of pain conditions and the need of support for many patients.

Implications

Increased knowledge about assessment, selection and treatment at pain clinics is important to improve the quality of the work performed at these clinics. Despite limited resources, further efforts should be made to collect comparable, valid data on a regular base from pain clinics in order to develop recommendation models.

Keywords: Chronic pain; Pain clinic; Longitudinal observational study; Pain treatment; Insomnia

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About the article

Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, and Unit of Anaesthesiology and Intensive Care, Sjukhusbacken 10, 118 83 Södersjukhuset, Stockholm, Sweden


Received: 2016-05-18

Revised: 2016-08-08

Accepted: 2016-08-15

Published Online: 2017-12-29


Implications: Increased knowledge of patients referred to, assessed and treated at pain clinics is important in order to improve the quality of the work done at these clinics. Despite limited resources, further efforts should be made to systematically collect information from pain clinics in order to develop recommendation models.

Ethical considerations: The study was approved by the Regional Ethical Review Board, Stockholm (Dnr: 2010/1903-31/5) with a supplementary application (Dnr: 2012/75-32). Patients were given oral and written information about the study and written consent was obtained from the participants before inclusion.

Conflict of interest statement: The authors have no conflict of interest.


Citation Information: Scandinavian Journal of Pain, Volume 17, Issue 1, Pages 233–242, ISSN (Online) 1877-8879, ISSN (Print) 1877-8860, DOI: https://doi.org/10.1016/j.sjpain.2016.08.004.

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