Background & Aims
In the UK, pain management programmes (PMPs) are the intervention of choice for chronic pain patients whose condition impacts their quality of life and biopsychosocial function[1]. PMPs are resource-intensive and expensive, yet show variability in outcomes across patients[2]. The aim of this systematic review was to identify prognostic factors in PMP outcomes for chronic pain patients, to either target patients who are most likely to benefit, or to provide training to improve “enabling factors” before a patient enters a PMP. Previous reviews have covered physical functioning, quality of life and pain outcomes[3,4,5], so the focus of this study was directed towards the other core outcome domain for chronic pain with enough studies to be synthesized; that being emotional functioning.
Methods
PsycInfo, MEDLINE, Cochrane CENTRAL, CINAHL & Embase were searched from inception to 31 August 2023. Eligible prognostic studies only included adult chronic pain patients where at least one emotional functioning outcome was measured at the beginning and the end of treatment. Risk of bias was assessed at study level using the Quality in Prognosis Studies (QUIPS) tool[6,7]. Grading of Recommendations Assessment, Development and Evaluation (GRADE)[8] was used to assess the quality of evidence. Potential baseline prognostic factors were synthesized narratively. A meta-analysis was unsuitable given heterogeneity between studies.
Results
Thirty-six studies, across 31,251 participants, were included in the review. Thirty-nine factors were found to have at least one significant association with change in emotional functioning over the course of a programme. Hope was the only factor found to have multiple significant associations and no non-associations. Other factors with multiple significant associations in a consistent direction were anxiety, employment status, pain intensity and pain disability/severity, although these factors all had more non-significant than significant associations. The only factors other than hope to have no non-significant associations only had one significant association (a “praying and hoping” coping style, experiential acceptance, overdoing/pain-related persistence, precontemplation, contemplation, high comfort attachment security, and positive emotionality/extraversion).
Conclusions
The GRADE quality of evidence for each potential prognostic factor ranged from very low to moderate, mostly downgraded due to lack of studies for certain factors, lack of specific hypotheses in the studies, and a high risk of bias. The lack of studies for some factors, mixed results for others, and the generally low quality of evidence mean that it is difficult to identify definitive prognostic factors in PMP outcomes for emotional functioning from this review. Future studies should focus hypotheses specifically on prognostic factors in this review, such as hope, that show potential but need further study. Future studies should also focus on clearer reporting to lower risk of bias ratings.
References
[1] British Pain Society (2021, October). Guidelines for pain management programmes for adults: an evidence-based review prepared on behalf of the British Pain Society. https://www.britishpainsociety.org/static/uploads/resources/files/PMP_guidelines_8QD8FJF.pdf
[2] Oehlerich, M. L., Geffen, G., Geffen, L., Craig, N., Geffen, S., Lovai, M., Hobson, J., & Day, M. A. (2021). Large-scale replication of psychological outcomes in a community-based interdisciplinary pain management program. Clinical Psychologist, 25(1), 98–106. https://doi.org/10.1080/13284207.2021.1900718
[3] Marttinen, M., Oura, P., Huttunen, M., Vartiainen, P., & Paananen, M. (2022). Determinants of responsiveness to multidisciplinary chronic pain management interventions: Protocol for a systematic review and meta-analysis. BMJ Open, 12(9), e057481. https://doi.org/10.1136/bmjopen-2021-057481
[4] Tseli, E., Boersma, K., Stålnacke, B.-M., Enthoven, P., Gerdle, B., Äng, B. O., & Grooten, W. J. A. (2019). Prognostic factors for physical functioning after multidisciplinary rehabilitation in patients with chronic musculoskeletal pain: A systematic review and meta-analysis. The Clinical Journal of Pain, 35(2), 148–173. psyh. https://doi.org/10.1097/AJP.0000000000000669
[5] Liechti, S., Tseli, E., Taeymans, J., & Grooten, W. (2023). Prognostic Factors for Quality of Life After Interdisciplinary Pain Rehabilitation in Patients with Chronic Pain—A Systematic Review. Pain Medicine, 24(1), 52–70. jlh. https://doi.org/10.1093/pm/pnac098
[6] Grooten, W. J. A., Tseli, E., Äng, B. O., Boersma, K., Stålnacke, B.-M., Gerdle, B., & Enthoven, P. (2019). Elaborating on the assessment of the risk of bias in prognostic studies in pain rehabilitation using QUIPS—aspects of interrater agreement. Diagnostic and Prognostic Research, 3(1), 5. https://doi.org/10.1186/s41512-019-0050-0
[7] Hayden, J. A., van der Windt, D. A., Cartwright, J. L., Côté, P., & Bombardier, C. (2013). Assessing Bias in Studies of Prognostic Factors. Annals of Internal Medicine, 158(4), 280–286. https://doi.org/10.7326/0003-4819-158-4-201302190-00009
[8] Huguet, A., Hayden, J. A., Stinson, J., McGrath, P. J., Chambers, C. T., Tougas, M. E., & Wozney, L. (2013). Judging the quality of evidence in reviews of prognostic factor research: Adapting the GRADE framework. Systematic Reviews, 2(1), 71. https://doi.org/10.1186/2046-4053-2-71
Presenting Author
Andrew Palmer
Poster Authors
Andrew Palmer
MSc
University of Liverpool, UK
Lead Author
Emilio Violato MSc
BA
Northern Alberta Institute of Technology, Canada
Lead Author
Michelle Maden PhD
University of Liverpool, UK
Lead Author
Monika Halicka
University of Bristol, UK
Lead Author
Katie Herron
he Walton Centre NHS Foundation Trust, UK
Lead Author
Jennifer Day
University of Manchester, UK
Lead Author
Laura Bonnett
University of Liverpool, UK
Lead Author
Selina Johnson
The Walton Centre NHS Foundation Trust, UK
Lead Author
Christopher Brown PhD
MSc
University of Liverpool, UK
Lead Author
Topics
- Systematic Reviews/Meta-Analysis