title: Impact of emotional distress and pain-related fear on patients with chronic pain: Subgroup analysis of patients referred to multimodal rehabilitation.
abstract: OBJECTIVE
  Multimodal rehabilitation programmes (MMRP) for chronic pain could be improved by determining which patients do not benefit fully. General distress and pain-related fear may explain variations in the treatment effects of MMRP.
  
  
  METHODS
  Cohort study with a cross-sectional, prospective part.
  
  
  METHODS
  Chronic musculoskeletal pain patients referred to 2 hospital-based pain rehabilitation clinics.
  
  
  METHODS
  The cross-sectional part of this study cluster analyses patients (n = 1,218) with regard to distress and pain-related fear at first consultation in clinical pain rehabilitation and describes differences in external variables between clusters. The prospective part follows the subsample of patients (n = 260) participating in MMRP and describes outcome post-treatment.
  
  
  RESULTS
  Four distinct subgroups were found: (i) those with low levels of distress and pain-related fear; (ii) those with high levels of pain-related fear; (iii) those with high levels of distress; and (iv) those with high levels of distress and pain-related fear. These subgroups showed differences in demogra-phics, pain characteristics, quality of life, and acceptance, as well as the degree of MMRP participation and MMRP outcome.
  
  
  CONCLUSIONS
  Among patients with chronic pain referred to MMRP there are subgroups with different profiles of distress and pain-related fear, which are relevant to understanding the adaptation to pain and MMRP outcome. This knowledge may help us to select patients and tailor treatment for better results.
authors.affiliation: Psychosomatic Medicine Clinic , Center for Health and Medical Psychology, Department of Law, Psychology and Social Work, Örebro University, 722 14 Västerås, Sweden. mikael.svanberg@ltv.se.
authors.forename: Mikael
authors.initials: M
authors.lastname: Svanberg
authors.forename: Britt-Marie
authors.initials: BM
authors.lastname: Stålnacke
authors.forename: Paul
authors.initials: P
authors.lastname: Enthoven
authors.forename: Gunilla
authors.initials: G
authors.lastname: Brodda-Jansen
authors.forename: Björn
authors.initials: B
authors.lastname: Gerdle
authors.forename: Katja
authors.initials: K
authors.lastname: Boersma
mesh_terms: D000328:Adult; D059350:Chronic Pain; D015331:Cohort Studies; D003430:Cross-Sectional Studies; D005239:Fear / Q000523:psychology*; D005260:Female; D006801:Humans; D008297:Male; D059408:Pain Management; D010147:Pain Measurement / Q000379:methods*; D011446:Prospective Studies; D013315:Stress, Psychological / Q000523:psychology*; D016896:Treatment Outcome