Improved health-related quality of life, participation, and autonomy in patients with treatment-resistant chronic pain after an intensive social cognitive intervention with the participation of support partners

Abstract

Despite the availability of various specific treatments, most patients with chronic pain (CP) consider their pain problem as undertreated. Recently, multiple sclerosis (MS) patients who were given an intensive 3-day social cognitive treatment with the participation of support partners experienced lasting improvements in health-related quality of life (HRQoL) and self-efficacy. In this study, a similar intervention was given to treatment-resistant CP patients with stressors, relational problems with support partner, and distress, anxiety or depression. Before and 1, 3, and 6 months after the intervention, patients completed the Euro-Qol 5 Dimensions 5 Levels (EQ-5D-5L) and Impact on Participation and Autonomy (IPA) questionnaires (primary outcomes), and the Survey Of Pain Attitudes (SOPA), the Four-Dimensional Symptom Questionnaire (4DSQ) (distress, depression, anxiety, and somatization), and Visual Analog Scale for pain intensity, whereas the support partners completed the Caregiver Strain Index (CSI) questionnaire. Differences between baseline and post-treatment were tested via paired t-tests (significance level 0.05). Of the 39 patients who were included, 34 (87.2%) completed the 3-day treatment. At 1, 3, and 6 months, improvements were seen in EQ-5D-5L-Index (+40.6%; +22.4%; +31.7%), Health Today (+61.8%; +36.3%; +46.8%), Control attitude (+45.8%; not significant [NS]; +55.0%) and decreases in IPA-Problems (−14.8%; NS; −20.4%), Harm attitude (−18.9%; −15.0%; −17.7%), Distress (−17.7%; −31.8%; −37.1%), and Depression (−37.4%; −31.4%; −35.7%) scores. The CSI score had decreased by −29.0%, −21.4%, and −25.9%, respectively. In conclusion, after an intensive 3-day social cognitive intervention, treatment-resistant CP patients experienced substantial and lasting improvements in HRQoL and in problematic limitations to participation and autonomy, in association with improvements in pain attitudes, depression, and distress. To assess whether this innovative approach may be an effective treatment for this subgroup of CP patients, future randomized controlled studies are needed.

Keywords:

• goal setting
• depression
• anxiety
• distress
• caregiver
• caregiver strain
• pain attitudes

Acknowledgments

We greatly acknowledge the contribution of Marco Heerings (MH-Advies en organisatiebureau, Assen, the Netherlands) to the online acquisition of the data and of Wim Lemmens (Radboud University Medical Centre, Department for Health Evidence) to the statistical analysis.

Author contributions

PJJ performed the conception and design of the study, coordination, data acquisition, analysis, and interpretation; he also drafted the manuscript. RR conceived and developed the treatment, was involved in the organization of the study, was a member of the multidisciplinary team, took part in data analysis and interpretation, and co-drafted the manuscript. YMM-K, TMCD, and AH took part in the development of the intervention, study organization, and data acquisition; they were part of the multidisciplinary team and revised the manuscript critically for important intellectual content. LD, JV-V, JC, and RL were involved in the development of the treatment, were members of the multidisciplinary team, have been involved in the acquisition of the data, and have revised the manuscript critically for important intellectual content. RD has been involved in the analysis and interpretation of the data and has revised the manuscript critically for important intellectual content. All the authors read and approved the submitted manuscript.

Disclosure

YMM-K, TMCD, and AH are employees of DC Klinieken Rotterdam. PJJ received fees for consultancy activities or unrestricted research grants from Bayer, Merck, Mylan, and TEVA. The other authors report no conflicts of interest in this work.