A German study examined whether multidisciplinary inpatient treatment for chronic neuropathic pain leads to improvement of pain in outcome and psychological variables at posttreatment and 3-month follow-up.
Within the field of chronic pain management, neuropathic pain remains a challenge, since it frequently resists treatment. While several studies have suggested that multidisciplinary treatment can help, evidence reviewing its overall effectiveness has been rare, even though neuropathic pain is marked by a high level of intensity, negative affectivity, as well as disability.
A study from Germany examined whether multidisciplinary treatment improves of clinical and psychological outcomes posttreatment and 3-month follow-up in patients with neuropathic pain. Clinical variables in the study were pain intensity and disability, and psychological variables were depression, pain acceptance, and catastrophizing. Researchers also wanted to know whether and to what extent psychological changes can predict long-term outcome at 3-month follow-up, controlling for baseline characteristics and changes in pain parameters.
What led to this study is the growing field of research that points to pain and disability as being not only influenced by somatic pathology, but also by social and psychological factors, such as depression and pain catastrophizing. The authors said another new concept in explaining the subjective processing of pain is the acceptance of pain. Pain acceptance is defined as the acknowledgment that one can be in pain and at the same time lead a satisfying life.
In this study, 141 patients suffering from a chronic neuropathic pain condition attended an inpatient multidisciplinary program lasting about 15 continuous days with self-report data collected at pretreatment, posttreatment, and 3-month follow-up. The average age of the group was 60.13 years, and most were women (64%). Most patients were married.
The multidisciplinary team included neurologists and physiotherapists, as well as occupational therapists, psychotherapists, and social workers. The treatment included drug therapy, physical approaches (such as exercise, physiotherapy, and rehabilitation), psychological approaches including psychological counseling, cognitive-behavioral interventions, self-help strategies, and the acquisition of pain management skills.
The treatment was tailored to the patients’ personal goals and type of pain and was performed in groups and on an individual basis.
The results showed a significant improvement of pain intensity, disability, pain acceptance, catastrophizing, and depression at posttreatment. These improvements remained stable over the 3-month follow-up for all variables, except depression. Researchers said the study showed the beneficial effects of an inpatient multidisciplinary program for neuropathic pain and further question the resistant nature of neuropathic pain to treatment. The results add evidence to the relevance of cognitive-behavioral interventions as well as the benefits of an inpatient multidisciplinary program for chronic neuropathic pain, the authors said.
The authors noted the lack of a conntrol group as one of the study limitations. In addition, they assessed psychological variables on self-report questionnaires, and the patients came from a single clinic. However, they said the results were consistent with previous research, and that the topic deserves further study.
Shaygan M, Böger A, Kröner-Herwig B. Predicting factors of outcome in multidisciplinary treatment of chronic neuropathic pain [published online October 18, 2018]. J Pain Res. doi: 10.2147/JPR.S175817.