Multidisciplinary Social Cognitive Intervention May Improve Quality of Life and Autonomy for Patients With Chronic Pain
The concept of this sociologically oriented approach lies in the identification and reduction of stressors that may limit the activities of patients with chronic pain.
An intensive social cognitive intervention delivered by a multidisciplinary team may lead to improvements in health-related quality of life, depressive symptoms, and autonomy in patients with chronic pain, according to a study published in the Journal of Pain Research.
In this study, patients with chronic pain followed an intervention termed the "Challenge," involving a support team composed of an anesthesiologist specializing in pain, a dance therapist, a registered pain consultant, a psychiatrist, a psychiatric nurse, and a physiotherapist.
The concept of this sociologically oriented approach lies in the identification and reduction of stressors that may limit the physical, social and psychological activities of patients with chronic pain. Five principles are at the core of the intervention: "identification and reduction of existing stressors; client-centeredness; inclusion of support partner (partner or a significant informal caregiver); group sessions; and the central notions of self-reliance, autonomy, and acceptance."
A total of 34 participants completed the 3-day intervention. Participants were found to experience improvements in mobility, self-care, usual activities, pain/discomfort, and anxiety/depression, all evaluated with the Euro-Qol 5 Dimensions 5 Levels questionnaire, at 1 month (+40.6%; P =.0003; n=33), 3 months (+22.4%; P =.0149; n=28), and 6 months (+31.7%; P =.0072; n=29) after the intervention. In addition, improvements were noted in "health today," as assessed with a Visual Analog Scale at 1 month (+61.8%; P <.0001), 3 months (+36.3%; P =.0086), and 6 months (+46.8%; P =.0374) and in patients' belief that their pain could be controlled effectively at 1 month (+45.8%; P =.0197) and 6 months (+55.1%; P =.0055).
Other improvements were also reported, including in issues associated with activity and autonomy, as assessed with the Impact on Participation and Autonomy 32-item questionnaire, with reductions at 1 month (−14.8%; P =.0103) and 6 months (−20.4%; P =.0115). At 1, 3, and 6 months after intervention, decreases were also noted in depression (−37.4%, −31.4%, and −35.7%, respectively), distress (−17.7%, −31.8%, and −37.1%, respectively), and harm attitude (−18.9%, −15.0%, and −17.7%, respectively) scores. The burden on caregivers, as evaluated with the Caregiver Strain Index, also decreased at 1, 3, and 6 months (−29.0%, −21.4%, and −25.9%. respectively).
Because this study lacked a control group, no causality can be made between the Challenge intervention and the observed improvements in health-related quality of life, participation, and autonomy.
The Challenge strategy appears to shows particular promise for autonomy improvement, as many patients with chronic pain are "often convinced that the anesthesiologist specialized in pain can control or cure the pain," which often results in greater dependency on the physician.
Jongen PJ, Ruimschotel RP, Museler-Kreijns YM, et al. 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. J Pain Res. 2017;10:2725-2738.