Development and implementation of an inpatient multidisciplinary pain management program for patients with intractable chronic musculoskeletal pain in Japan: preliminary report

Figures & data

Figure 1 Changes of pain and associated factors.

Notes: *p<0.05.
Abbreviations: BPI, brief pain inventory; EQ-5D, EuroQol five dimensions questionnaire; HADS, hospital anxiety and depression scale; PCS, pain catastrophizing scale; PDAS, pain disability assessment scale; PSEQ, pain self-efficacy questionnaire.

Figure 2 Changes in physical functions.

Note: *p<0.05.

Table 1 Characteristics of 14 cases

Case	Chief complaint	Structural disorder	Psychiatric diagnosis
1. 41-year-old man	Low back pain	None found	Pervasive developmental disorder, attention deficit hyperactivity disorder, somatoform disorders
2. 53-year-old woman	Posterior cervical pain, bilateral omalgia, low back pain	None found	Dependency personality disorder, somatoform disorders
3. 69-year-old woman	Posterior cervical pain, bilateral omalgia, low back pain	Spondylosis	Compulsive personality disorder, somatoform disorders
4. 55-year-old woman	Posterior cervical pain, bilateral upper extremity numbness	Ossification of posterior longitudinal ligament (after surgery)	Narcissism personality disorder
5. 20-year-old man	Low back pain	None found	Pervasive developmental disorder, attention deficit hyperactivity disorder, somatoform disorders
6. 56-year-old woman	Posterior cervical pain, bilateral omalgia, low back pain, bilateral gonalgia	Spondylosis, knee osteoarthritis	Attention deficit hyperactivity disorder, dependency personality disorder, somatoform disorders
7. 31-year-old woman	Posterior cervical pain, bilateral omalgia, low back pain	None found	None diagnosed
8. 47-year-old woman	Low back pain	None found	Attention deficit hyperactivity disorder, histrionic personality disorder, somatoform disorders
9. 56-year-old woman	Low back pain, left leg pain	None found	None diagnosed
10. 51-year-old man	Low back pain	None found	Pervasive developmental disorder, attention deficit hyperactivity disorder, somatoform disorders
11. 55-year-old man	Posterior cervical pain, bilateral omalgia, back pain, bilateral arm pain, low back pain, bilateral leg pain	None found	Pervasive developmental disorder, autism spectrum disorder, attention deficit hyperactivity disorder, somatoform disorders
12. 58-year-old woman	Posterior cervical pain, bilateral omalgia, low back pain, right coxalgia, bilateral gonalgia, bilateral leg pain	Right hip osteoarthritis, 4^th lumbar degenerative spondylolisthesis	Pervasive developmental disorder, attention deficit hyperactivity disorder, somatoform disorders
13. 75-year-old woman	Low back pain, bilateral leg pain	Spondylosis	None diagnosed
14. 73-year-old woman	Low back pain, bilateral leg pain	Spondylosis, scoliosis	None diagnosed

Table 2 Changes of pain and associated factors

	Before program (Average ± standard error)	After program (Average ± standard error)	p-value
BPI	23.4 ±2.9	19.4 ±2.3	0.001
PCS (rumination)	15.3 ±1.0	12.6 ±1.1	0.01
PCS (magnification)	6.7 ±1.0	4.5 ±0.8	0.003
PCS (helplessness)	11.8 ±1.4	7.7 ±0.9	0.007
PCS (total)	33.8 ±3.1	24.8 ±2.6	0.003
PDAS	29.1 ±3.2	17.9 ±3.1	0.02
HADS (anxiety)	8.8 ±1.2	5.8 ±1.0	0.004
HADS (depression)	9.6 ±1.4	6.7 ±1.3	0.03
PSEQ	19.5 ±2.9	34.1 ±3.1	0.0002
EQ-5D	0.525 ±0.05	0.643 ±0.04	0.04

Abbreviations: BPI, brief pain inventory; EQ-5D, EuroQol five dimensions questionnaire; HADS, hospital anxiety and depression scale; PCS, pain catastrophizing scale; PDAS, pain disability assessment scale; PSEQ, pain self-efficacy questionnaire.

Table 3 Changes of physical functions

	Before program (Average ± standard error)	After program (Average ± standard error)	p-value
Static flexibility test (flexibility)	24.7 ±2.9 cm	31.8 ±2.8 cm	0.15
30-second sit to stand test (muscle endurance)	14.2 ±2.4 times	18.2 ±2.9 times	0.02
2-step test (walking ability)	203.2 ±15.0 cm	224.5 ±12.3 cm	0.15
6 minutes walking test (physical fitness)	411.7 ±40.7 m	475.1 ±42.5 m	0.03

Table 4 Changes of the various scores after treatment in a representative patient

	Before treatment	3W treatment
Degree of pain
BPI	24	21
Psychosocial factors
PCS (rumination)	20	8
PCS (magnification)	16	10
PCS (helplessness)	9	3
PDAS	29	7
HADS (anxiety)	15	9
HADS (depression)	19	6
PSEQ	10	40
QOL score
EQ-5D	0.384	0.724

Abbreviations: BPI, brief pain inventory; EQ-5D, EuroQol five dimensions questionnaire; HADS, hospital anxiety and depression scale; PCS, pain catastrophizing scale; PDAS, pain disability assessment scale; PSEQ, pain self-efficacy questionnaire; 3W, 3 weeks.

Table 5 Changes of physical function after treatment in a representative patient

	Before treatment	3W treatment
Flexibility
Static flexibility test (cm)	22	36.5
Muscle endurance
30-second sit to stand test (times)	10	15
Walking ability
2-step test (cm)	246	295
Physical fitness
6-minute walking test (m)	375	397

Abbreviation: 3W, 3 weeks.

Table 6 Inpatient multidisciplinary pain management programs in other countries

Facility	Staff	Hospitalization	Treatment method	Outcomes
Washington Center for Pain Relief (Seattle, WA, USA)	Rehabilitation medicine physicians, pain psychologists, physical and occupational therapists, vocational counselors	4 weeks	Multidisciplinary rehabilitation program, which includes physical exercise and reconditioning, and psychological strategies for managing pain and the associated emotional and behavioral changes	Improvements in reported pain, pain worry, fear-avoidance beliefs, depression, and physical function, 74% of patients returned to work or underwent retraining
Center for Clinical Psychology and Rehabilitation, University of Bremen (Bremen, Germany)	Physicians, nurses, therapists, clinical psychologist	3–4 weeks	Multidisciplinary inpatient orthopedic rehabilitation program, which includes physical exercise training, cognitive behavioral therapy, progressive muscle relaxation, and psychological counseling	Significantly improved psychological and pain-related outcome measures, especially anxiety level
Institute for Physiotherapy, Bern University Hospital (Bern, Switzerland)	Rheumatologists, clinical psychologists, physiotherapists, occupational therapists, nurses, a movement analyst, and a humor therapist	4 weeks	Interdisciplinary approach including drug therapy, physiotherapy (aerobic endurance training, qigong/tai chi exercises), and individual psychotherapy that includes cognitive behavioral therapy, relaxation therapy, humor therapy, and education in coping skills	Significantly improved pain scores, mental health, and coping outcomes
University of Duisburg-Essen (Essen, Germany)	Physicians, nurses, mind–body therapists	2 weeks	Multidisciplinary pain management program, which includes classical naturopathy (hydrotherapy, thermotherapy, manual therapy, massage, physiotherapy, exercise, nutritional therapy, and fasting), stress reduction, nutritional counseling, and self-help skills	Significant improvements in pain intensity, pain disability, pain perception, quality of life, depression, and perceived stress
Chronic Pain Management and Neuromodulation Centre at St. Thomas’s Hospital (London, UK)	Anesthesiologists, clinical psychologists, physical therapists, occupational therapists, and nurses	4 weeks	An inpatient cognitive behavioral pain program with physical and psychological assessment, exercise therapy and stretching, and relaxation technique training	Significant improvements for all measures of psychological and physical function. A majority of patients were satisfied with the treatment
Auckland City Hospital (Auckland, New Zealand)	Registered psychiatrists, medical and nursing staff, psychologists, physiotherapists, occupational therapists, and vocational rehabilitation officers	4 weeks	Cognitive behavioral pain program, which includes education about physiology and psychology in pain; behavioral pain management; promoting adaptive cognitions via cognitive restructuring, visualization, and imagery techniques; exercise; individual, group, family, and vocational counseling; medication; and staff verbal reinforcement of patients’ activity	Significant improvements at posttreatment for measures of psychological distress, pain behavior, health-related disability, and pain intensity following physical exertion