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Earlier pain management for better results
Julkaistu 30.04.2010 00.01
Background
The aims of traditional pain management programmes conducted by a multi-disciplinary rehabilitation team are to develop appropriate pain coping skills, improve management of life, organise the life situation, assuage disability and regain overall functioning. This project was conducted to study the functionality of a new pain management programme involving collaboration between primary healthcare, specialized healthcare, national insurance and the rehabilitation centre. A second aim was to investigate the possibility of responding earlier to the needs of pain patients, as well as to identify the potential benefits of an earlier response.
Methods
The sample, gathered during the years 2003-2005, comprised 191 pain patients, of whom 98 were in the traditional two-phase pain management programme and 93 in the new three-phase network programme. The 15D quality of life inventory, Oswestry pain disability index, BDI depression inventory, BAI anxiety inventory, TAS20 alexithymia scale, TSK fear of movement inventory and an inquiry about physical activity were used as standardised inventories in the project.
Results
There were 59% females in the traditional programme group and 65% in the new programme group. The average age was 45 years in the traditional programme group, 44 years in the new programme group. Quality of life did not significantly improve in either group, nor did changes in quality of life differ significantly between the groups. Both a depression diagnosis in the referral and depression in the initial phase of the programme predicted a statistically significant positive change in quality of life. In the new programme group depression decreased significantly, while no significant change in depression could be found in the traditional programme group. Anxiety at the beginning of the programme predicted a statistically significant negative rehabilitation outcome in terms of change in quality of life. At six months follow-up, the anxiety level was significantly lower only in the new programme group. The difference remained significant at 12 months follow-up. There was a significant reduction in the fear of movement in the new programme group at 12 months follow-up. In the traditional programme group a significant reduction was found only at six months follow-up. Physical activity increased significantly in both groups. The 5-minute walking test improved in both groups.
Conclusions
The majority of patients gained benefits from the process in the form of a decrease in pain intensity and a consequently increased sense of management. Exercising under supervision of experts in a confident atmosphere enabled confrontation of the pain more appropriately and realistically without irrelevant fear. As a result of the rehabilitation the patients were able to limit their activities both by lowering their own demands and expectations as to what they should be able to accomplish and by learning to resist external pressure in this respect.
Timo Pohjolainen, Docent, Chief Physician, ORTON Rehabilitation
Tage Orenius, Heikki Hurri, Maija Haanpää
Finnish Medical Journal 2010;65:1535–1544
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