Improvements in interoceptive sensibility, pain and functional clinical outcome measures after participation in an
Stephanie Voss1,2, Shannon La Penna2, Alison Yum2
1Health and Kinesiology Department, University of Illinois Urbana-Champaign, Urbana, Illinois, USA.
Background:
Altered interoception, the sense of signals from inside the body, is linked to chronic pain. No studies to date have examined whether interoceptive sensibility, one's self-reported beliefs about the body and tendencies to be internally focused, changes following participation in an interdisciplinary pain management program (IPMP).
Objective:
The primary aim was to determine whether interoceptive sensibility changes following IPMP participation. The second aim was to explore whether change in interoceptive sensibility could explain improvement in functional outcomes.
Methods:
An observational cohort study was conducted at an outpatient pain management center housed within an urban academic rehabilitation center. A heterogeneous sample of 53 (mean age = 50.3, 81.1% female) patients with high-impact chronic pain completed study measures in addition to receiving interdisciplinary care with physical therapy, occupational therapy, and psychology. Measures included the Multidimensional Assessment of Interoceptive Awareness (MAIA-2), Patient-Reported Outcomes Measurement Information System Pain Intensity and Interference short forms, Canadian Occupational Performance Measure (COPM), and the Patient Specific Functional Scale. Paired t-tests examined change in outcomes from program start to program completion. Hierarchical linear regressions tested the unique contribution of change in interoceptive sensibility on functional outcomes.
Results:
There was a significant increase in interoceptive sensibility and improvement on all pain and functional outcomes (p's < .001, absolute d's = 0.70-1.55). Six of the eight MAIA-2 subscales increased significantly (p's < .001, d's = 0.42-0.83), with the greatest increase in the Self-Regulation and Not Worrying subscales. An increase in overall interoceptive sensibility contributed an additional 6.3% (β = 0.267, p < .05) and 15.8% (β = 0.424, p ≤ .001) to the variance in improved COPM-Performance and COPM-Satisfaction scores after program completion, respectively.
Discussion:
This study provides emerging evidence that interoceptive sensibility improves following IPMP participation and is associated with improved functional engagement in high-impact chronic pain.
Conclusion:
IPMPs may be uniquely suited to improving interoceptive self-regulation, which could be an important treatment target in chronic pain. More research is needed to examine the role of interoceptive sensibility in different pain conditions as well as the impact of cultural, demographic, and psychosocial differences on interoceptive sensibility in chronic pain.
