Multidisciplinary Pain Rehabilitation Programs in Iceland: An Exploration and Description of the Short-term and Long-term Effects

Abstract

Aim: The overall aim of the thesis was to explore and describe the short- and long-term effects of three multidisciplinary pain rehabilitation programs on pain severity and pain interference and the long-term effects on pain self management, sleep quality, well-being, health, and health-related quality of life (HRQOL). Content of the thesis: This thesis consists of three original papers. Paper I comprises a phenomenological study, while Papers II and III present results from longitudinal prospective cohort studies. People in chronic pain who were on a waiting list for multidisciplinary pain rehabilitation at one of three centres in Iceland – Reykjalundur, Kristnes and Rehabilitation and Health Clinic at Hveragerði– were invited to participate. The program lasted between four and seven weeks, with data collected pre-treatment, at program completion, three months after program completion and in a one-year follow-up. Methods: Paper I was a phenomenological study that employed the Vancouver School of Doing Phenomenology. Eleven participants were interviewed, with 11 interviews conducted pre-treatment and 10 occurring three months after the participants had completed the intervention. Paper II was a longitudinal prospective cohort study with questionnaires filled out pre treatment, at completion and at one-year follow-up. Paper III was a longitudinal prospective cohort study with questionnaires completed pre treatment and at one-year follow-up. Results: Most participants were women aged 20–69 (M = 47.3) who were married or living with a partner. Paper I: The overarching theme was the journey of breaking the vicious circle of chronic pain. Prior to attending rehabilitation, the participants were in survival mode, stuck in a vicious circle of chronic pain. They used a variety of strategies to relieve and conceal their pain. Reaching out for professional help was a positive turning point. Whilst attending the pain rehabilitation program, participants learned to deconstruct their habitual but inefficient ways of dealing with chronic pain. Three months after completing the program, they were still rebuilding their daily lives. Pain was still present but interfered much less with daily activities than previously. Paper II: Eighty-one participants responded to all three questionnaires. Average self-reported pain severity decreased at program completion and at one-year follow-up (p < 0.001), and the interference of pain with general activities, mood, walking ability, sleep and enjoyment of life also declined. At one-year follow-up, more than a fifth (21%) of participants rated their health as good or very good, which was markedly better than before treatment (7%; p < 0.001). The three most commonly used pain self-management strategies pre-treatment were positive thinking (68%), medication (58%) and distraction (58%). No change was found in use of pain self-management strategies between pre-treatment and one-year follow-up. Paper III: Seventy-nine participants responded to both questionnaires. Participants scored their pain lower at one-year follow-up than pre-treatment (p < 0.001). At one year follow-up, three times as many participants (18%) slept through the night (p = 0.004) as had done so pre-treatment (6%). Most had disrupted sleep, mainly because of pain and psychological problems, at both the pre-treatment and one-year follow-up time points. HRQOL increased at one-year follow-up, with higher scores in all areas except the Mental Component Summary (MCS). The pre-treatment Physical Component Summary (PCS) was the only potential predictor for PCS at one-year follow up. Higher pre-treatment MCS scores and having pursued higher education predicted higher MCS scores at one-year follow-up. Sleep problems, being a woman and having children under 18 years predicted lower MCS scores at one-year follow-up. Conclusion: Pain rehabilitation programs can be the first step toward breaking the vicious circle of chronic pain. The intervention was effective for participants at one-year follow-up. Their self-reported pain severity and pain interference had decreased, Moreover, their health and HRQOL increased. However, they had failed to continue using the methods highlighted in the pain rehabilitation program, and their sleep problems persisted. The findings reveal the need for more emphasis on sleep problems and mental health in connection with chronic pain in multidisciplinary pain rehabilitation interventions. Therefore, some sort of follow-up is recommended for support, education and maintaining the long-term effect of the intervention.