title: Patients with chronic pain: One-year follow-up of a multimodal rehabilitation programme at a pain clinic.
abstract: Multimodal rehabilitation (MMR) programmes, including, physical training, educational and psychological interventions by an interdisciplinary team are found to be more successful for patients with disabling chronic pain compared with less comprehensive treatments. MMR programmes are based on the biopsychosocial model and the goal is usually to improve function, quality of life and facilitate and enable return to work. As pain clinics traditionally offer conventional medical pain treatment, there is limited knowledge about MMR given in this context. The aim of our study was to describe characteristics of patients with chronic pain, treated with a MMR programme at a conventional pain clinic, to evaluate patient-reported outcome measures (PROM) from start to one year after, and to study possibly associated factors for the improvement of health-related quality of life after one year.
  
  
  
  A prospective, observational study with a one-year follow-up was performed.
  
  
  
  A total of 42 individuals (38 females, age 44.0±12.3 years and 4 men age 40±8.5 years) with different pain diagnoses were included. After a team assessment, the patients began a programme that lasted about three months. The MMR programme contained coordinated, individually adapted treatments administered individually or in groups, and was based on cognitive behavioural principles. Questionnaires regarding health-related quality of life (HRQoL) (EQ-5D), insomnia (ISI), mental health (HADS), pain-related disability (PDI), kinesiophobia (TSK), current pain intensity (VAS) and sense of coherence (SOC) were used at the start of the MMR and at follow-up. Demographic data were collected from the patient records.
  
  
  
  The PROM at baseline showed substantial pain problems with low HRQoL (EQ-5D index of 0.1±0.282, and EQ VAS of 32.67±20.1), moderate insomnia (ISI 18.95±6.7), doubtful cases of depression and anxiety (HADS-depression 9.35±4.1 and HADS-anxiety 9.78±3.95), presence of pain-related disability (PDI 39.48 ±12.64), kinesiophobia (TSK 40.8±9.8), as well as moderate current pain (VAS 61.31±20.4). The sense of coherence was weak (SOC of 51.37±14). At one-year follow-up, significant (p≤0.05) improvement occurred on the EQ-5D index, EQ VAS, ISI, PDI and TSK. In the logistic regression analysis, no significant associations could be identified.
  
  
  
  MMR for patients with complex pain problems can be a successful treatment alternative at conventional pain clinics.
  
  
  
  Since access to rehabilitation clinics in Sweden may be limited, the availability of MMR can increase by providing this type of intervention in pain clinics. Increased knowledge of MMR in different settings can also contribute to increased understanding and collaboration between pain clinics and rehabilitation units.
authors.affiliation: Karolinska Institutet, Department of Clinical Science and Education, Section of Anaesthesiology and Intensive Care, Sjukhusbacken 10, Södersjukhuset, Stockholm 118 83,StockholmSweden.
authors.forename: Andrea
authors.initials: A
authors.lastname: Hållstam
authors.affiliation: Karolinska Institutet, Department of Clinical Sciences, Danderyd Hospital, Division of Rehabilitation Medicine, Stockholm 182 88, StockholmSweden.
authors.forename: Monika
authors.initials: M
authors.lastname: Löfgren
authors.affiliation: Karolinska Institutet, Department of Clinical Science and Education, Section of Anaesthesiology and Intensive Care, Sjukhusbacken 10, Södersjukhuset, Stockholm 118 83,StockholmSweden.
authors.forename: Christer
authors.initials: C
authors.lastname: Svensén
authors.affiliation: Department of Community Medicine and Rehabilitation, Rehabilitation Medicine, Umeå University, Umeå 901 85, UmeåSweden.
authors.forename: Britt-Marie
authors.initials: BM
authors.lastname: Stålnacke
mesh_terms: D000328:Adult; D059350:Chronic Pain / Q000534:rehabilitation*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D018710:Pain Clinics; D010147:Pain Measurement; D011446:Prospective Studies; D011788:Quality of Life; D013548:Sweden
keywords: Chronic pain; Longitudinal observational study; Multimodal rehabilitation; Pain clinic