Predictors of Responsivity to Interdisciplinary Pain Management

Abstract

Objective

This study investigated for whom interdisciplinary pain management (IPM) is most effective. Identification of predictors of treatment responsivity would facilitate development of patient-treatment matching algorithms to optimize outcomes.

Design

Repeated measures prospective study of consecutive admissions to a two-week IPM program.

Setting

Brisbane Pain Rehabilitation Service in Brisbane, Australia.

Subjects

A total of 163 adults referred for chronic pain management.

Methods

Self-report questionnaires and measures of physical performance were obtained at program entry and completion. Group-level analyses were performed using standard parametric statistics. Individual-level change was assessed using recommended criteria. Multivariate analysis of variance and logistic regression were used to examine outcomes and predictors of response.

Results

Significant improvements were observed across psychological, social, and physical outcome domains. Up to 50% of participants had clinically meaningful improvements, while less than 10% deteriorated. Higher baseline depression, anxiety, stress, and pain catastrophizing scores predicted better group-level outcomes (Ps < 0.05). Participants with higher baseline depression scores were most likely to show significant individual-level improvement on at least one outcome (Ps < 0.05). Participants with nociceptive pain were more than four times more likely than those with neuropathic pain to show clinically meaningful improvement on multiple outcomes, while those participants who were older were more likely to be multidomain responders.

Conclusions

Physical, psychological, and social outcomes all improved in a significant proportion of participants following the IPM. High baseline depression was a clinically reliable predictor of individual-level improvement. Individuals with nociceptive pain and those who were older, respectively, showed the largest response across multiple outcomes and domains.

Chronic Pain, Interdisciplinary Pain Management, Clinical Outcome Predictors