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

Figures & data

Figure 1 Scatter plots visualizing individual responses for those outcomes that showed statistically significant changes at six months. The X-axis represents the score at baseline, and the Y-axis the score at 6 months after the intervention.

Abbreviations: CSI, Caregiver Strain Index; EQ-5D-5L, Euro-Qol 5 Dimensions 5 Levels; IPA, Impact on Participation and Autonomy; SOPA, Survey Of Pain Attitudes; VAS, visual analog scale.

Table 1 Mean (SD) (minimum–maximum) EQ-5D-5L-Index, VAS Health Today, IPA-Limitations, and IPA-Problems values at baseline and at 1, 3, and 6 months after intervention

Outcome measures	Baseline (n=34)	Month 1 (n=33)	Month 3 (n=28)	Months 6 (n=29)
EQ-5D-5L-Index	0.43 (0.21) (−0.03–0.79)	0.57 (0.22) (0.02–0.84) (P<0.0001)	0.54 (0.24) (0.11–0.87) (P=0.0091)	0.56 (0.22) (0.17–0.87) (P=0.0012)
VAS Health Today	37.6 (16.2) (7–65)	55.9 (19.9) (12–80) (P<0.0001)	48.1 (24.1) (10–85) (P=0.0162)	46.4 (25.3) (8–83) (P=0.0021)
IPA-Limitations	2.1 (0.6) (1–3)	1.9 (0.7) (1–3) (P=0.0335)	2.1 (0.7) (0–3) (P=0.9971)	1.9 (0.08) (1–3) (P=0.1138)
IPA-Problems	1.3 (0.4) (0–2)	1.1 (0.5) (0–2) (P=0.0552)	1.1 (0.5) (0–2) (P=0.0276)	1.1 (0.6) (0–2) (P=0.0070)

Note: P-values for comparisons between baseline and post-intervention.

Abbreviations: EQ-5D-5L, Euro-QoL 5 dimensions 5 levels; IPA, Impact on Participation and Autonomy; SD, standard deviation; VAS, visual analog scale.

Table 2 Mean (SD) (minimum–maximum) values for VAS Actual, Minimum and Maximum pain, SOPA attitudes Control, Emotion, Disability, Harm, Medication, Solicitude, and Medical, and 4DSQ symptoms Distress, Depression, Anxiety, and Somatization at baseline and at 1, 3, and 6 months after intervention

Outcome measures	Baseline (n=34)	Month 1 (n=33)	Month 3 (n=28)	Months 6 (n=29)
Actual pain (0–10)	6.7 (1.9) (0–10)	6.1 (2.1) (2–10) (P=0.2808)	6.1 (1.7) (2–9) (P=0.4385)	5.7 (2.3) (2–9) (P=0.0095)
Minimal pain (0–10)	3.7 (1.8) (0–7)	3.6 (2.0) (0–7) (P=0.7704)	4.0 (2.0) (1–8) (P=0.2668)	3.7 (2.0) (0–8) (P=0.6676)
Maximal pain (0–10)	8.3 (2.2) (0–10)	7.8 (1.7) (4–10) (P=0.3093)	7.8 (1.8) (0–9) (P=0.6590)	8.0 (1.8) (2–10) (P=0.2676)
Control	47.2 (6.3) (34–59)	50.0 (9.6) (28–68) (P=0.0476)	49.1 (10.6) (26–68) (P=0.1867)	52.2 (10.2) (24–78) (P=0.0035)
Emotion	52.1 (11.5) (30–80)	55.1 (12.5) (38–80) (P=0.0602)	52.7 (12.1) (30–80) (P=0.8262)	54.4 (11.1) (30–80) (P=0.4765)
Disability	54.2 (9.0) (40–74)	50.7 (10.0) (28–72) (P=0.0233)	53.4 (9.7) (40–72) (P=0.6226)	51.1 (12.6) (25–74) (P=0.0461)
Harm	55.2 (8.1) (42–74)	51.0 (9.8) (34–76) (P=0.0016)	54.0 (10.5) (36–80) (P=0.0256)	51.8 (10.3) (28–72) (P=0.0027)
Medication	47.5 (6.7) (31–59)	47.7 (6.6) (37–62) (P=0.9313)	47.4 (6.6) (35–59) (P=0.8103)	46.8 (5.7) (33–59) (P=0.5029)
Solicitude	48.2 (10.2) (32–80)	44.8 (10.0) (32–63) (P=0.0025)	45.2 (10.8) (32–65) (P=0.0538)	46.1 (12.1) (32–72) (P=0.0457)
Medical cure	54.8 (7.7) (34–75)	52.1 (6.3) (34–63) (P=0.0095)	51.6 (8.0) (36–75) (P=0.0070)	50.1 (9.8) (27–66) (P=0.0300)
Distress	20.4 (8.1) (7–32)	15.8 (8.9) (1–32) (P=0.0018)	14.5 (10.4) (0–32) (P<0.0001)	14.4 (10.4) (0–32) (P<0.0001)
Depression	4.7 (4.5) (0–12)	3.0 (3.7) (0–12) (P=0.0023)	3.5 (4.6) (0–12) (P=0.0262)	3.6 (4.4) (0–12) (P=0.0072)
Anxiety	5.7 (5.8) (0–20)	4.0 (4.9) (0–20) (P=0.0271)	3.6 (5.2) (0–21) (P=0.1853)	3.6 (5.3) (0–21) (P=0.0204)
Somatization	17.2 (4.5) (9–26)	14.7 (5.1) (7–26) (P=0.0098)	14.5 (5.2) (4–26) (P=0.0233)	14.0 (6.9) (3–29) (P=0.0173)

Note: P-values for comparisons between baseline and post-intervention.

Abbreviations: SD, standard deviation; SOPA, Survey Of Pain Attitudes; VAS, visual analog scale, 4DSQ, Four-Dimensional Symptom Questionnaire.

Table 3 CSI (mean) (SD) (minimum–maximum) values at baseline and at 1, 3, and 6 months after intervention; CSI percentage changes (mean) (SEM) (median) post-intervention; and the number (Nr) (percentage) of support partners with a CSI ≥7 at various time points

Outcome measures	Baseline (n=29)	Month 1 (n=27)	Month 3 (n=26)	Month 6 (n=25)
CSI (0–13)	5.6 (3.3) (0–11)	3.7 (2.7) (0–9) (P=0.0008)	4.1 (3.4) (0–11) (P=0.0264)	4.4 (3.7) (0–12) (P=0.0222)
CSI % Δ (SEM) (median)		−29.0% (9.7) (−37.5%) (P=0.0065)	−21.4% (10.2) (−25.0%) (P=0.0467)	−25.9% (8.7) (−26.1%) (P=0.0069)
Nr. (%) CSI ≥7	12 (41%)	4 (15%)	5 (19%)	8 (32%)

Note: P-values for comparisons with baseline.

Abbreviations: CSI, Caregiver Strain Index; SD, standard deviation; SEM, standard error of mean.

Table 4 Mean percentage change (standard error) (median) from baseline for the primary and secondary outcome measures

Outcome measures	Month 1 (n=33)	Month 3 (n=28)	Months 6 (n=29)
(A) Primary outcome measures
EQ-5D-5L-Index	+40.6% (9.9) (+32.2%) (P=0.0003)	+22.4% (8.6) (+11.4%) (P=0.0149)	+31.7% (10.9) (+10.4%) (P=0.0072)a
VAS Health Today	+61.8% (12.5) (+37.5%) (P<0.0001)	+36.3% (12.8) (+23.0%) (P=0.0086)	+46.8% (21.4) (+16.7%) (P=0.0374)
IPA-Limitations	NSb	NS	NS
IPA-Problems	−14.8% (5.4) (−12.7%) (P=0.0103)	NS	−20.4% (7.5) (−11.1%) (P=0.0115)
(B) Secondary outcome measures
Actual pain	NS	NS	−14.6 (6.2) (−0.0%) (P=0.0248)
Minimal pain	NS	NS	NS
Maximal pain	NS	NS	NS
Control	+45.8% (18.7) (+23.5%) (P=0.0197)	NS	+55.1% (18.3) (+31.6%) (P=0.0055)
Emotion	+50.7% (20.9) (11.2) (P=0.0212)	NS	NSc
Disability	NS	NS	NS
Harm	−18.9% (8.1) (−21.4%) (P=0.0267)	−15.0% (5.8) (−9.6%) (P=0.0158)	−17.7% (6.4) (−9.5%) (P=0.0095)
Medication	NS	NS	NS
Solicitude	−16.8% (7.5) (−9.1%) (P=0.0328)	NS	NS
Medical cure	NS	−13.2% (6.4) 16.5%) (P=0.0487)	NS
Distress	−17.7% (7.6) (−21.9%) (P=0.0252)	−31.8% (6.9) (−19.8%) (P<0.0001)	−37.1% (6.6) (−33.3%) (P<0.0001)
Depression	−37.4% (8.8) (−33.3%) (P=0.0003)	−31.4% (10.6) (−8.3%) (P=0.0076)	−35.7% (8.7) (−33.3%) (P=0.0004)
Anxiety	NS	NS	NS
Somatization	−11.7% (4.6) (−16.7%) (P=0.0172)	−12.9% (6.2) (−15.1%) (P=0.0455)	−16.8% (6.7) (−13.0%) (P=0.0181)

Notes: P-values for comparisons with baseline.

a Comparison based on n=26; NS (P>0.05).

b Nonsignificant (P<0.05).

c P=0.0556.

Abbreviations: EQ-5D-5L, Euro-QoL 5 Dimensions 5 Levels; IPA, Impact on Participation and Autonomy; NS, not significant; VAS, visual analog scale.