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Treatment Outcomes for Workers Compensation Patients in a US‐Based Interdisciplinary Pain Management Program
Author(s) -
Gag Christine M.,
Stanos Steven P.,
van der Ende Geke,
Rader Lynn R.,
Harden R. Norman
Publication year - 2013
Publication title -
pain practice
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.899
H-Index - 58
eISSN - 1533-2500
pISSN - 1530-7085
DOI - 10.1111/j.1533-2500.2012.00586.x
Subject(s) - medicine , physical therapy , visual analogue scale , beck depression inventory , anxiety , pain catastrophizing , state trait anxiety inventory , depression (economics) , chronic pain , psychiatry , economics , macroeconomics
Objectives: Assess the efficacy of an outpatient‐based interdisciplinary pain rehabilitation program for patients with active workers compensation claims. Patients: Data were available for 101 patients, primarily with chronic low back pain (75%), who participated in the program. Methods: Treatment included a 4‐week (Monday to Friday), 8‐hours/day graded progressive program that included individual and group therapies (pain psychology, physical therapy, occupational therapy, relaxation training/biofeedback, aerobic conditioning, pool therapy, vocational counseling, patient education and medical management). Outcome measures included program completion status, release‐to‐work status, return‐to‐work status, total scores on the Beck Depression Inventory, State‐Trait Anxiety Inventory, Pain Catastrophizing Scale, and the McGill Pain Questionnaire Visual Analogue Scale (MPQ VAS). The majority of the patients (65%) graduated from the program. Pre‐postoutcome data were available for those who graduated from the program. For noncompleters, last obtained MPQ VAS was compared with their initial MPQ VAS scores. Results: Of those completing the program, most patients (91%)were released to return to work; with 80% released to full‐time status and 11% released to gradual return. Approximately half (49%) of the program completers returned to work. Paired‐samples t ‐tests showed that program completers had significant reductions in depression ( P = 0.000), pain‐related catastrophizing ( P = 0.033), and pain intensity ( P = 0.000), but not in anxiety ( P = 0.098). Interestingly, the last obtained (at early discharge/withdrawal) pain intensity scores ( M = 70.33) were higher than at baseline ( M = 61.20) in the noncompleters. This difference was not statistically significant ( P = 0.127) but may be clinically meaningful. Discussion: Our results support the efficacy of an outpatient‐based 4‐week interdisciplinary pain rehabilitation program in decreasing emotional distress, reducing pain intensity, and improving return‐to‐work status in the majority of completers in this challenging population. Patients reporting increased pain at discharge or those discharged early may have been due to operant factors.