title: Clinical effectiveness of a residential pain management programme - comparing a large recent sample with previously published outcome data.
abstract: OBJECTIVE
  Observational studies using routinely collected data indicate that pain management programmes (PMPs) based on cognitive-behavioural principles are associated with clinically meaningful improvements for individuals with chronic pain. This study evaluated change across functional measures in a sample of chronic pain patients attending a 4-week residential PMP between 2006 and 2010. The findings were directly compared with published outcomes from an earlier period (1989-1998) at the same service.
  
  
  METHODS
  Participants included 760 consecutive completers of a multidisciplinary PMP. Data were collected at pre-PMP, post-PMP (1-month post-discharge) and at a 9-month follow-up session. Group-based treatment effects and the reliability and clinical significance of change across functional measures were calculated and compared across cohorts.
  
  
  RESULTS
  Effect sizes for the recent cohort ranged from small to medium (.43-.67) for pain and physical functioning outcomes to large (.90-1.12) for psychological outcomes at post-treatment (n = 654), and from small (.30-.51) to medium (.58-.71) at 9-month follow-up (n = 493). Clinically significant gains on pain and psychological measures were achieved by 19-55% of patients at post-treatment and 17-44% at follow-up. Comparisons with the earlier cohort showed significantly stronger post-treatment outcomes but differences at follow-up were less marked.
  
  
  CONCLUSIONS
  These results add to the evidence base supporting the effectiveness of cognitive-behavioural therapy (CBT)-based pain management interventions. There were significantly larger gains in patient functioning in the recent dataset, suggesting improved programme delivery. But effects were less marked in the longer term, indicating a need for improvements in therapeutic models and related methods to promote meaningful and lasting changes.
authors.affiliation: Population Health Research Institute, St George's, University of London, London, UK.
authors.forename: Jared G
authors.initials: JG
authors.lastname: Smith
authors.affiliation: INPUT Pain Management Unit, Guy's and St Thomas' NHS Foundation Trust, London, UK.
authors.forename: Lucie
authors.initials: L
authors.lastname: Knight
authors.affiliation: INPUT Pain Management Unit, Guy's and St Thomas' NHS Foundation Trust, London, UK.
authors.forename: Amy
authors.initials: A
authors.lastname: Stewart
authors.affiliation: Population Health Research Institute, St George's, University of London, London, UK.
authors.forename: Emma L
authors.initials: EL
authors.lastname: Smith
authors.affiliation: INPUT Pain Management Unit, Guy's and St Thomas' NHS Foundation Trust, London, UK.
authors.forename: Lance M
authors.initials: LM
authors.lastname: McCracken
keywords: Chronic pain; clinical significance; interdisciplinary; pain management programme; reliable change