Background & Aims
Chronic pain is a widespread health problem influenced by many factors developing over time (Treede, 2019). Management requires understanding of the complex interplay between biomedical pain generators, psychosocial determinants, ethnocultural factors, gender dynamics etc (Wakefield EO, 2018). Research demonstrates linkage between chronic pain and social determinants eg. where people are born, live, or work, socioeconomic status, rurality, occupational status, neighborhood, and education (Dobson, 2022). For example, patients with lower education (Núñez-Cortés, 2019), or those living in lower socioeconomic status neighborhoods report significantly higher levels of chronic pain (Deangelis, 2022). Often existence of social risk factors is not acknowledged. Our study goal is to investigate how social determinants (socioeconomic status, level of education, access to healthcare, gender and ethnic origins etc) affect the outcome of chronic pain management at an interdisciplinary clinic.
Methods
A retrospective longitudinal study was conducted on 64 chronic pain patients treated in an interdisciplinary, publicly funded, non-interventional 3-month pain program in a community-based pain clinic in the Greater Toronto Area, Ontario, Canada after meeting specific eligibility criteria (Mailis and Lakha, 2019). The patients completed after detailed informed consent specific questionnaires in four key data collection points – entry, exit at 3 months, and 6 and 12-month visits after program exit (2019 – 2022). Patients provided on entry data re: age, sex, marital status, work status, country of birth, education, pain characteristics and duration of pain, and were classified as Canadian Born (CB) and Foreign Born (FB) based on country of birth. Outcome data on emotional and functional status were obtained by validated questionnaires (BPI, GAD, CESD, SF12, TSK, PSEQ, PCS, CAPQ8) at all 4 data collection points with addition of the Global Impression for Change (GIC) in the last three.
Results
Women (n=49) outnumbered men (n=15) (female: male ratio 3.3:1, p= <0.05); mean age 46.2; 13% were >65 years; 75% Canadian born, 61% employed, and 69% had extended health benefits. Low back pain was reported by 80%; however,75% had multisite /widespread pain. At entry, mean Numerical Rating Scale was 6+/-1.5. All validated battery scores were normally distributed as per histograms, skewness, and kurtosis. Average baseline scores were 26?10 for self-efficacy, 25?11 for pain catastrophizing, 10?5 for GAD, 42 ?12 for BPI interference score, 24 ?10 for CESD. Significant improvements were sustained across all emotional and functional batteries at all data collection points. At 12-months post exit scores improved as follows (compared to baseline): 58% for self-efficacy, 52% for pain catastrophizing, 30% for GAD, 43% for BPI interference score, 33% for CESD, while 66% of the participants (n=42/64) reported “much improvement” in GIC. Detailed analysis and additional data will be presented.
Conclusions
This study presents long-term data (up to 12 months post-graduation) from a series of chronic pain patients admitted to a Canadian community-based, comprehensive, one-to-one, interdisciplinary pain management program funded by the Ontario Ministry of Health and Long Term Care (MOHLTC). Appropriately selected patients obtain sustained improvement one year after exiting the program in multiple physical and emotional domains. Most importantly, public funding provides social medicine and allows admission to the program of all eligible candidates and not only those who can afford the program.
References
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