Using Quantitative Sensory Testing to Predict Attrition in an Interdisciplinary Pain Management Program: A Pilot Study

Abstract

Aim: To determine the extent to which quantitative sensory testing (QST) predicted attrition in an interdisciplinary pain program (IPP). Patients & methods: Participants (n = 53) enrolled in an IPP completed pretreatment assessments of QST and the PROMIS-29 quality of life survey. Results & conclusion: Compared with completers, non-completers (24.5%) reported significantly higher pain intensity (7.1, 95% CI [5.8, 8.4] versus 5.4, 95% CI [4.8, 6.1]) and cold hyperalgesia (14.6°C, 95% CI [8.8, 20.4] versus 7.5°C, 95% CI [4.8, 6.1]), with both variables also predicting attrition. This finding highlights a potentially novel and clinically significant use of QST. Higher overall pain intensity and the presence of remote cold hyperalgesia may identify patients at risk for dropping out of an IPP.

Plain language summary

The purpose of this research study was to determine the extent to which quantitative sensory testing (QST) predicted which patients enrolled in an interdisciplinary pain program (IPP) would drop out. Fifty-three patients with chronic pain enrolled in an IPP were assessed before treatment with mechanical and thermal QST at a painful and a non-painful site, as well as with the PROMIS-29 quality of life survey. Pretreatment findings were compared between non-completers (i.e., attended five or fewer sessions for any component of the IPP) and completers. Resulting significant predictors were included in a logistic regression to predict attrition. Compared with those who completed the program, non-completers (24.5%) reported significantly higher pain intensity and oversensitivity to cold at a non-painful site pretreatment, with both variables also predicting completion of the IPP. In summary, these preliminary findings suggest that higher overall pain intensity and the presence of cold oversensitivity (at baseline) may identify patients at risk for dropping out of an IPP.

Keywords::

• attrition
• central sensitization
• chronic pain
• interdisciplinary pain management program
• quantitative sensory testing

Acknowledgments

The authors appreciate the patients who consented to participate in this study conducted in the Interdisciplinary Pain Program at the Eugene McDermott Center for Pain Management. The authors are grateful for the administrative support of the Departments of Anesthesiology, Physical Therapy and Psychiatry.

Financial & competing interests disclosure

Funded by the David M Crowley Foundation and UT Southwestern School of Health Professions Interdisciplinary Research Grant. RB Jarrett is a paid consultant to the NIH, NIMH and UptoDate. RB Jarrett has equity holdings in Amgen, Johnson and Johnson, and Procter and Gamble, and her medical center charges fees for the cognitive therapy she provides to patients. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

No writing assistance was utilized in the production of this manuscript.

Ethical conduct of research

The authors state that they have obtained appropriate institutional review board approval or have followed the principles outlined in the Declaration of Helsinki for all human or animal experimental investigations. In addition, for investigations involving human subjects, informed consent has been obtained from the participants involved.

Additional information

Funding

Funded by the David M Crowley Foundation and UT Southwestern School of Health Professions Interdisciplinary Research Grant. RB Jarrett is a paid consultant to the NIH, NIMH and UptoDate. RB Jarrett has equity holdings in Amgen, Johnson and Johnson, and Procter and Gamble, and her medical center charges fees for the cognitive therapy she provides to patients. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed. No writing assistance was utilized in the production of this manuscript.