A longitudinal study of the efficacy of a comprehensive pain rehabilitation program with opioid withdrawal: comparison of treatment outcomes based on opioid use status at admission.

UNLABELLED: Use of opioids for chronic non-cancer pain is controversial and the efficacy of comprehensive pain rehabilitation programs (CPRPs) that incorporate opioid withdrawal requires further investigation. We test the hypothesis that patients with chronic pain and longstanding opioid use who undergo opioid withdrawal in the course of rehabilitative treatment will experience significant and sustained improvement in pain and functioning similar to patients who were not taking opioids. A longitudinal design study compared 373 consecutive patients admitted to the Mayo Clinic Pain Rehabilitation Center at admission, discharge and six-month posttreatment by opioid status at admission. Measures of pain severity, depression, psychosocial functioning, health status, and pain catastrophizing were used to assess between- and within-group differences. Treatment involved a 3-week interdisciplinary pain rehabilitation program focused on functional restoration. Over one-half of patients (57.1%) were taking opioids daily at admission. The majority of patients (91%) completed rehabilitation and 70% of patients who completed the program returned questionnaires six months posttreatment. On admission, patients taking low- and high-dose opioids reported significantly greater pain severity (P=.001) and depression (P=.001) than the non-opioid group. Significant improvement was found on all outcome variables following treatment (P<.001) and six-month posttreatment (P<.001) regardless of opioid status at admission. There were no differences between the opioid and non-opioid groups upon discharge from the program or at six months following treatment. CONCLUSION: Patients with longstanding CPRP on chronic opioid therapy, who choose to participate in interdisciplinary rehabilitation that incorporates opioid withdrawal, can experience significant and sustained improvement in pain severity and functioning.

Physical and emotional functioning of adult patients with chronic abdominal pain: comparison with patients with chronic back pain.

UNLABELLED: Adults with chronic abdominal pain remain a poorly defined population, despite the debilitation and depression associated with this therapeutically challenging condition. This study compared patients with chronic abdominal pain with an empirically well-known group of patients with chronic pain (back pain) to investigate similarities and differences in their physical and mental functioning. This retrospective, cross-sectional study included 136 patients with abdominal pain and 364 patients with back pain seen in a comprehensive pain rehabilitation center. Patients' functioning was assessed with the Short Form-36 Health Survey, Multidimensional Pain Inventory, Center for Epidemiological Studies-Depression scale, and Coping Strategies Questionnaire-Catastrophizing subscale. Both the abdominal and back pain patients reported long-standing and severe pain, numerous surgery procedures, poor functioning, and high prevalence of depression. When age, education, and marital status were controlled for, analyses showed that although patients with abdominal pain reported significantly better physical functioning than patients with back pain (P < .001), their overall health perception was significantly poorer (P < .001). Although less prevalent, it is clear that patients with chronic abdominal pain exhibit poor functioning and prevalence of depression that are comparable to patients with chronic back pain. This study also suggests distinct characteristics that are vital to consider for effective treatment of this chronic pain population. PERSPECTIVE: As a result of being an overlooked and poorly defined population, adults with chronic abdominal pain might not receive adequate pain management treatment. Learning more about the physical and emotional functioning of patients with long-standing abdominal pain can increase recognition of the needs of and improve treatment for this population.

Chronic noncancer pain rehabilitation with opioid withdrawal: comparison of treatment outcomes based on opioid use status at admission.

OBJECTIVE: To study differences in treatment outcomes between patients with chronic noncancer pain taking vs those not taking maintenance opioids at admission to a pain rehabilitation program. PATIENTS AND METHODS: A nonrandomized 2-group prepost design was used to compare 356 patients admitted to the Mayo Comprehensive Pain Rehabilitation Center from January 2002 to December 2002 at admission and discharge by opioid status at admission. Measures of pain severity, interference due to pain, perceived life control, affective distress, activity level, depression, and catastrophizing (an exaggerated negative mental set associated with actual or anticipated pain experiences) were used to compare opioid and nonopioid groups. The patients entered a 3-week intensive outpatient multidisciplinary pain rehabilitation program designed to improve adaptation to chronic noncancer pain. The program uses a cognitive-behavioral model and incorporates opioid withdrawal. RESULTS: More than one third of patients (135/356) were taking opioids daily at admission. At completion of the program, all but 3 of the 135 patients had successfully discontinued opioid treatment. No significant pretreatment differences were found between the opioid and nonopioid group regarding demographics, pain duration, treatment completion, or all outcome variables, including pain severity. Significant improvement was noted at discharge for all outcome variables assessed regardless of opioid status at admission. CONCLUSION: Patients with symptomatically severe and disabling pain while taking maintenance opioid therapy can experience significant improvement in physical and emotional functioning while participating in a pain rehabilitation program that incorporates opioid withdrawal.