Does systematic graded exposure in vivo enhance outcomes in multidisciplinary chronic pain management groups?
OBJECTIVE
Graded exposure in vivo (GEXP) treatment has been successfully used to reduce levels of pain-related fear and disability in some chronic pain patients, but its effectiveness has not been evaluated in general clinical settings using group-design studies. The purpose of this study was to determine if the systematic incorporation of GEXP into a multidisciplinary chronic pain management group (PMG) treatment program would result in better treatment outcomes than usual PMG treatment.


METHODS
One hundred forty-three chronic pain patients who were assessed as suitable for an outpatient multidisciplinary chronic PMG program were randomly allocated to 3 experimental conditions; usual PMG, PMG incorporating systematic graded exposure, and wait-list control.


RESULTS
The clinical outcomes of the 2 treatment conditions were not significantly different, suggesting that the systematic incorporation of GEXP into a multidisciplinary PMG program did not result in better treatment outcomes than usual PMG treatment. Both group treatment programs were associated with significant treatment effects when compared with the wait-list control on measures of pain intensity, fear of movement/(re)injury, pain self-efficacy, activity level, and depression. No treatment effects were found on self-report measures of pain disability or anxiety.


CONCLUSIONS
The addition of systematic graded exposure into a multidisciplinary chronic pain management program did not result in better clinical outcomes than the usual group treatment program. The validity of GEXP to the broader population of chronic pain patients warrants further investigation.
Bliokas
Vida V
VV
Rehabilitation Psychology Department and Illawarra Pain Management Service, Port Kembla Hospital, Warrawong, NSW, Australia. Vida.Bliokas@sesiahs.health.nsw.gov.au
Cartmill
Tania K
TK
Nagy
Barbara J
BJ
D000203:Activities of Daily Living; D000704:Analysis of Variance; D001007:Anxiety; D002908:Chronic Disease; D003131:Combined Modality Therapy; D003863:Depression / Q000209:etiology; D003887:Desensitization, Psychologic / Q000379:methods*; D004185:Disability Evaluation; D004311:Double-Blind Method; D005239:Fear; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D010146:Pain / Q000523:psychology* / Q000534:rehabilitation*; D018710:Pain Clinics; D010147:Pain Measurement / Q000379:methods; D012189:Retrospective Studies; D016896:Treatment Outcome