Evaluation of group and individual change in a multidisciplinary pain management program.

OBJECTIVES: Systematic reviews have consistently shown that multidisciplinary interventions are more effective than waitlist and other unimodal active treatments for a range of chronic pain conditions. However, these group-based statistics fail to inform us whether these programs result in clinically meaningful improvement at the individual level. The current study examines group changes and individual responsiveness to a CBT-informed multidisciplinary chronic pain management program. METHODS: The analyses are based on data obtained from 263 outpatients. In addition to examining group-based treatment effects, we evaluated individual responsiveness to the program using 3 different criteria for assessing clinically important change. RESULTS: Statistically significant improvement was found for all measures at posttreatment, with effect sizes ranging from small to medium. Gains were largely maintained at follow-up. The results of the clinically important change analysis revealed that not everyone improved uniformly, and the magnitude of change varied across the 3 different methods. This variability in the extent of improvement prompted further analyses in an attempt to identify individual differences that could predict responsiveness to treatment. No differences were found between responders and nonresponders to treatment. DISCUSSION: The results of our study are consistent with previous research, and highlight the potential for multidisciplinary programs to improve the well-being of individuals with chronic pain. Clinically important change analyses underscore the variability that exists in chronic pain patients and allows for a more fine grained evaluation of individual responsiveness to treatment. Considering the strengths and limitations of each methodological approach for assessing clinically important change, guidelines are offered for future research and program development.

Spinal cord stimulation in pregnancy: a literature review.

OBJECTIVE: Currently, the use of spinal cord stimulation (SCS) therapy is not recommended in pregnancy because the effects of SCS on the pregnancy and developing fetus are unknown. However, many SCS recipients are women of childbearing age who may later become pregnant. The purpose of the present report is to review and summarize the existing literature on the use of SCS therapy during the prenatal period. METHODS: We first present the case of a 38-year-old woman from our center who became pregnant after receiving an SCS implantation. We then provide a synopsis of previous reports that were identified in a literature search. We highlight the key findings from these cases as they relate to the course of pregnancy, fetal development, labor and delivery management, fertility, and technical complications. RESULTS: In our literature review, we identified 12 cases of pregnancy in 8 women. To these we add the present case. CONCLUSIONS: Women of childbearing age who are candidates for SCS implantation should be tested for pregnancy prior to implantation surgery. They also should be informed about the limited state of our scientific knowledge regarding the impact of this technology on reproductive health. For patients already implanted with SCS, decisions about ongoing use in the event of pregnancy should be made on an individual basis after a careful consideration of potential risks and benefits.

Comparative efficacy, speed, and adverse effects of three PTSD treatments: exposure therapy, EMDR, and relaxation training.

The authors examined the efficacy, speed, and incidence of symptom worsening for 3 treatments of posttraumatic stress disorder (PTSD): prolonged exposure, relaxation training, or eye movement desensitization and reprocessing (EMDR; N = 60). Treaments did not differ in attrition, in the incidence of symptom worsening, or in their effects on numbing and hyperarousal symptoms. Compared with EMDR and relaxation training, exposure therapy (a) produced significantly larger reductions in avoidance and reexperiencing symptoms, (b) tended to be faster at reducing avoidance, and (c) tended to yield a greater proportion of participants who no longer met criteria for PTSD after treatment. EMDR and relaxation did not differ from one another in speed or efficacy.