title: Expectations predict chronic pain treatment outcomes.
abstract: Accumulating evidence suggests an association between patient pretreatment expectations and numerous health outcomes. However, it remains unclear if and how expectations relate to outcomes after treatments in multidisciplinary pain programs. The present study aims at investigating the predictive association between expectations and clinical outcomes in a large database of chronic pain patients. In this observational cohort study, participants were 2272 patients treated in one of 3 university-affiliated multidisciplinary pain treatment centers. All patients received personalized care, including medical, psychological, and/or physical interventions. Patient expectations regarding pain relief and improvements in quality of life and functioning were measured before the first visit to the pain centers and served as predictor variables. Changes in pain intensity, depressive symptoms, pain interference, and tendency to catastrophize, as well as satisfaction with pain treatment and global impressions of change at 6-month follow-up, were considered as treatment outcomes. Structural equation modeling analyses showed significant positive relationships between expectations and most clinical outcomes, and this association was largely mediated by patients' global impressions of change. Similar patterns of relationships between variables were also observed in various subgroups of patients based on sex, age, pain duration, and pain classification. Such results emphasize the relevance of patient expectations as a determinant of outcomes in multimodal pain treatment programs. Furthermore, the results suggest that superior clinical outcomes are observed in individuals who expect high positive outcomes as a result of treatment.
authors.affiliation: Département de psychoéducation et de psychologie, Université du Québec en Outaouais, Gatineau, QC, Canada School of Nursing, McGill University, Montréal, QC, Canada Centre de recherche, Centre hospitalier de l'Université de Montréal, Montréal, QC, Canada Département d'anesthésiologie, Université de Montréal, Montréal, QC, Canada Département de stomatologie, Université de Montréal, Montréal, QC, Canada Centre de recherche, Institut universitaire de gériatrie de Montréal, Montréal, QC, Canada Centre de recherche en neuropsychologie et cognition, Montréal, QC, Canada Groupe de recherche sur le système nerveux central, Montréal, QC, Canada.
authors.forename: Stéphanie
authors.initials: S
authors.lastname: Cormier
authors.forename: Geneviève L
authors.initials: GL
authors.lastname: Lavigne
authors.forename: Manon
authors.initials: M
authors.lastname: Choinière
authors.forename: Pierre
authors.initials: P
authors.lastname: Rainville
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D058443:Catastrophization / Q000523:psychology; D059350:Chronic Pain / Q000150:complications / Q000523:psychology* / Q000628:therapy*; D003863:Depression / Q000175:diagnosis / Q000209:etiology; D005260:Female; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D015233:Models, Statistical; D059408:Pain Management / Q000379:methods*; D010147:Pain Measurement; D017060:Patient Satisfaction; D011237:Predictive Value of Tests; D011569:Psychiatric Status Rating Scales; D012189:Retrospective Studies; D057566:Self Report; D016896:Treatment Outcome; D055815:Young Adult