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Scandinavian Journal of Pain

Official Journal of the Scandinavian Association for the Study of Pain

Editor-in-Chief: Breivik, Harald

4 Issues per year


CiteScore 2017: 0.84

SCImago Journal Rank (SJR) 2017: 0.401
Source Normalized Impact per Paper (SNIP) 2017: 0.452

Online
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1877-8879
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Volume 17, Issue 1

Identifying characteristics of the most severely impaired chronic pain patients treated at a specialized inpatient pain clinic

Eva-Britt Hysing / Lena Smith / Mans Thulin / Rolf Karlsten / Stephen Butler / Torsten Gordh
Published Online: 2017-10-01 | DOI: https://doi.org/10.1016/j.sjpain.2017.09.008

Abstract

Background and aims

Patients suffering from chronic nonmalignant pain constitute a heterogeneous population in terms of clinical presentation and treatment results. Few data are available about what distinguishes different groups in this huge population of patients with chronic persistent pain (CPP). A subgroup that is poorly studied, consists of the most severely impaired chronic pain patients. At the Uppsala University Hospital Pain Clinic, there is a specialized department accepting the most complex patients for rehabilitation. In the endeavour to improve and evaluate treatment for this subgroup, a better understanding of the complex nature of the illness is essential. This prospective study aimed to describe the characteristics of this subgroup of patients with CPP.

Methods

Seventy-two consecutive patients enrolled in the Uppsala programme were evaluated. We collected data on demographics, type of pain and experienced symptoms other than pain using a checklist of 41 possible symptoms. Psychiatric comorbidity was assessed by a psychiatrist using a structured clinical interview. Quality of life (QoL), pain rating and medication/drug/alcohol usage were measured by validated questionnaires: SF-36, NRS, DUDIT and AUDIT. Concerning physical functioning and sick leave, a comparison was made with data from the Swedish Quality Register Registry for pain rehabilitation (SQRP).

Results

The cohort consisted of 61% women and the average age was 45 (range 20-70) years. For this cohort, 74% reported being on sick leave or disability-pension. In the SQRP 59% were on sick leave at the time they entered the rehabilitation programmes [1]. On average, the study-population reported 22 symptoms other than pain, to be at a high rate of severity. Patients treated in conventional pain-rehabilitation programmes reported a mean of 10 symptoms in average. Symptoms reported with the highest frequency (>80%), were lethargy, tiredness, headache and difficulties concentrating. Seventy- six percent were diagnosed with a psychiatric disorder. Sixty-nine fulfilled the criteria for depression or depression/anxiety disorder despite that most (65%) were treated with psychotropic medication. Alcohol/drug abuse was minimal. Seventy-one percent were on opioids but the doses were moderate (<100 mg) MEq. The pain rating was ≥7 (out of a maximum of 10) for 60% of the patients.

Conclusion

This study describes what makes the subgroup of pain patients most affected by their pain special according to associated factors and comorbidity We found that they were distinguished by a high degree of psychiatric comorbidity, low physical functioning and extreme levels of symptom preoccupation/hypervigilance. Many severe symptoms additional to pain (e.g. depression/anxiety, tiredness, disturbed sleep, lack of concentration, constipation) were reported. The group seems hypervigilant, overwhelmed with a multitude of different symptoms on a high severity level.

Implications

When treating this complex group, the expressions of the illness can act as obstacles to achieve successful treatment outcomes. The study provides evidence based information, for a better understanding of the needs concerning these pain patients. Our result indicates that parallel assessment and treatment of psychiatric comorbidities and sleep disorders combined with traditional rehabilitation, i.e. physical activation and cognitive reorganization are imperative for improved outcomes.

Keywords: Characterization of patients with severe; chronic persistent pain; Subgrouping patients with chronic; persistent pain; Severely impaired patients with chronic; pain; Psychiatric comorbidity; Physical dysfunction; Systemic symptoms other than pain

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About the article

Department of Surgical Science, Uppsala University, SE-751 85 Uppsala, Sweden


Received: 2017-06-28

Revised: 2017-09-08

Accepted: 2017-09-09

Published Online: 2017-10-01

Published in Print: 2017-10-01


Funding: Uppsala University Hospital, Uppsala University, Uppsala Berzelii Center.

Ethical issues: The study was performed in full accordance with the Declaration of Helsinki (1965 and later revisions). The study was approved by the Regional Ethical Review Board in Uppsala, Sweden (Dnr 2010/182). The patients included in the study were informed and gave written informed consent.

Conflict of interest: No conflicts of interest.

Authors’ contribution: EBH and LS oversaw and participated in all data collection, TG and EBH designed the protocol, and wrote the manuscript, RK and SB provided technical and interpretational advice and edited the manuscript and MT analyzed the data and performed the statistical analyses. All authors approved the final manuscript.


Citation Information: Scandinavian Journal of Pain, Volume 17, Issue 1, Pages 178–185, ISSN (Online) 1877-8879, ISSN (Print) 1877-8860, DOI: https://doi.org/10.1016/j.sjpain.2017.09.008.

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