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Outpatient cognitive behavioral pain management programs: a randomized comparison of a group-based multidisciplinary
Lynne Turner-Stokes1, Feza Erkeller-Yuksel, Anne Miles
1Department of Rehabilitation, Northwick Park Hospital, King's College London, UK. lynne.turner-stokes@dial.pipex.com
Objective:
To compare the efficacy of 2 models of chronic pain management.
Design:
Randomized comparative trial with 2 active treatment arms.
Setting:
Outpatient pain management clinics.
Participants:
A total of 113 adults with chronic pain of 0.5 to 38 years duration in (mean, 8.8y).
Interventions:
Cognitive behavioral therapy (including education, relaxation, use of cognitive coping strategies, pacing, exercise) delivered in group-based multidisciplinary program or in an individual therapy program.
Main Outcome Measures:
Self-report of interference with daily activities and sense of control over pain (West Haven-Yale Multidimensional Pain Inventory [WHYMPI]) and depression (Beck Depression Inventory). Secondary outcome measures were state anxiety (Spielberger State-Trait Anxiety conventory), analgesic medication consumption, general activity, and pain severity (WHYMPI). Measurement points were 0 (before treatment), 2 months (end of treatment), and 3, 6 and 12 months (follow-up).
Results:
No significant differences were found between the 2 modes of treatment at any of the major time points (0, 2, 12mo). Both treatment conditions made significant and sustained improvements on all primary outcome measures, although sense of control over pain tended to decline by 1 year. Individually treated participants made slower gains in some areas, but showed a lesser tendency to rebound at the end of treatment.
Conclusion:
The 2 programs appear to be equally efficacious for pain management in adults with chronic pain. In practical terms, the choice of model for service provision may rest more on local issues such as the availability of space and staff time.