Background
Aims
Methods
Design
Sample
Intervention
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manifest or impending impairment of quality of life and/or ability to work
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failure of a uni-modal pain therapy in the patient’s anamnestic history or failure of an operative procedure that was administered to relieve pain, or failure of a pain-medication withdrawal treatment
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existing pain medication dependency or abuse
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psychic comorbidity that contributes to manifesting the pain condition
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serious somatic comorbidity
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A physical exercise program (every day): general fitness exercises, muscle strengthening exercises, stretching
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Education (every day): anatomy, pain, and physical and mental coping strategies
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Relaxation training (every day): progressive muscle relaxation, applied relaxation
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Optional therapy-related drug treatment or physiotherapy
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Individual physical counseling (once a week): vicious circle of pain, realistic goal determination, individually based medical therapy
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Individual psychological counseling (once a week): cognitive-behavioral intervention, treatment of individual emotional distress
Development of the success criterion
Five subcriteria
Integrating the subcriteria into a combined success criterion
Minimum | Maximum | Mean | Standard Deviation | |
---|---|---|---|---|
Change in average pain severity t2-t1 | −7.00 | 3.11 | −1.99 | 1.94 |
Change in PDI t2-t1 | −8.00 | 4.57 | −1.72 | 1.89 |
Change in ADS t2-t1 | −46.00 | 30.00 | −12.24 | 10.77 |
Change in SF-36 physical t2-t1 | −10.86 | 32.49 | 6.95 | 7.08 |
Change in SF-36 mental t2-t1 | −29.61 | 37.28 | 8.29 | 12.24 |
Instruments
Statistical analysis
Empirical evaluation of the success criterion
Predictors of successful pain therapy
Sensitivity analysis predictors
Results
Success criterion
Number of fulfilled (improved) single success criteria | Combined Success Criterion | Sensitivity Analysis | ||
---|---|---|---|---|
(1/2 SD improvement) | (1 SD improvement) | |||
Frequency (N) | % | Frequency (N) | % | |
0 | 10 | 2.7 | 27 | 7.2 |
1 | 15 | 4.0 | 53 | 14.1 |
2 | 46 | 12.3 | 83 | 22.1 |
3 | 86 | 22.9 | 84 | 22.4 |
4 |
113
|
30.1
| 94 | 25.1 |
5 |
105
|
28.0
| 34 | 9.1 |
Total | 375 | 100.0 | 375 | 100.0 |
Empirical evaluation of the success criterion
Convergent validity
Successes | Non-Successes | T | p | Correlation | |
---|---|---|---|---|---|
Mean (SD) | Mean (SD) | ||||
FESV scale 1: Depression | 44.42 (8.10) | 49.65 (9.08) | 5.869 | <.001 | −.291** |
FESV scale 2: Fear | 44.55 (7.91) | 47.35 (9.37) | 3.044 | <.01 | −.160** |
FESV scale 3: Anger | 48.36 (8.29) | 50.08 (8.67) | 1.952 | n.s.a | −.101 |
FESV scale 4: Competences in planning | 61.33 (6.01) | 58.90 (6.63) | −3.701 | <.001 | .188** |
FESV scale 5: Cognitive restructuring | 58.12 (7.34) | 54.31 (8.25) | −4.715 | <.001 | .237** |
FESV scale 6: Sense of competence | 56.55 (7.37) | 52.98 (8.58) | −4.327 | <.001 | .219** |
FESV scale 7: Mental distraction | 57.95 (8.55) | 55.38 (8.74) | −2.840 | <.01 | .145** |
FESV scale 8: Countersteering activities | 53.50 (8.80) | 51.49 (9.11) | −2.155 | <.05 | .111* |
FESV scale 9: Relaxation techniques | 60.64 (7.41) | 58.17 (8.73) | −2.870 | <.01 | .151** |
Predictive validity
Discriminative validity
Predictors of success in multi-modal pain therapy
Regression Coefficient β | Standard error | Wald | df | p | OR | 95 % Confidence Interval for OR | ||
---|---|---|---|---|---|---|---|---|
Lower Value | Upper Value | |||||||
Age | −.016 | .010 | 2.755 | 1 |
.097
| 0.984 | 0.966 | 1.003 |
Sex | −.229 | .237 | 0.933 | 1 | .334 | 0.795 | 0.500 | 1.266 |
Living situation | −.161 | .280 | 0.331 | 1 | .565 | 0.851 | 0.492 | 1.473 |
School education | .408 | .231 | 3.122 | 1 |
.077
| 1.504 | 0.956 | 2.365 |
Employment | .145 | .217 | 0.444 | 1 | .505 | 1.156 | 0.755 | 1.769 |
Number of affected pain regions | .001 | .014 | 0.011 | 1 | .918 | 1.001 | 0.974 | 1.029 |
Localization of primary pain: | ||||||||
head | .180 | .289 | 0.387 | 1 | .534 | 1.197 | 0.679 | 2.111 |
upper body | −.286 | .217 | 1.738 | 1 | .187 | 0.751 | 0.491 | 1.149 |
lower body | −.103 | .234 | 0.194 | 1 | .660 | 0.902 | 0.571 | 1.427 |
joints | .571 | .377 | 2.288 | 1 | .130 | 1.769 | 0.845 | 3.706 |
whole body | .063 | .350 | 0.032 | 1 | .858 | 1.065 | 0.536 | 2.113 |
Pain perception affective (SES) | .028 | .012 | 5.842 | 1 |
.016
| 1.029 | 1.005 | 1.053 |
Pain perception sensory (SES) | .001 | .015 | 0.006 | 1 | .936 | 1.001 | 0.972 | 1.031 |
Frequency of primary pain | −.192 | .238 | 0.655 | 1 | .418 | 0.825 | 0.518 | 1.314 |
Average pain severity in the last 4 weeks | .289 | .063 | 20.695 | 1 |
<.001
| 1.335 | 1.179 | 1.511 |
Highest pain severity in the last 4 weeks | .359 | .083 | 18.456 | 1 |
<.001
| 1.431 | 1.215 | 1.686 |
Lowest pain severity in the last 4 weeks | .126 | .045 | 7.828 | 1 |
.005
| 1.134 | 1.038 | 1.239 |
Actual pain severity | .133 | .045 | 8.830 | 1 |
.003
| 1.143 | 1.046 | 1.248 |
Acceptable pain severity after treatment | .023 | .062 | 0.137 | 1 | .712 | 1.023 | 0.906 | 1.156 |
Persuasibility of pain | .276 | .252 | 1.200 | 1 | .273 | 1.318 | 0.804 | 2.160 |
Number of symptoms accompanying pain | .002 | .047 | 0.003 | 1 | .959 | 1.002 | 0.914 | 1.099 |
Number of psychic comorbidities | .142 | .150 | 0.898 | 1 | .343 | 1.153 | 0.859 | 1.547 |
Park-Indexa | .273 | .190 | 2.068 | 1 | .150 | 1.314 | 0.906 | 1.905 |
Disability due to Pain (PDI) | .348 | .066 | 28.218 | 1 |
<.001
| 1.417 | 1.246 | 1.611 |
Depressiveness (ADS) | .029 | .010 | 8.387 | 1 |
.004
| 1.029 | 1.009 | 1.049 |
Physical-health-related quality of life (SF-36) | −.021 | .014 | 2.095 | 1 | .148 | 0.980 | 0.953 | 1.007 |
Mental-health-related quality of life (SF-36) | −.025 | .009 | 7.413 | 1 |
.006
| 0.976 | 0.959 | 0.993 |
Number of personal physician switches | .060 | .056 | 1.162 | 1 | .281 | 1.062 | 0.952 | 1.184 |
Number of pain-associated physician visits in the last six months | −.023 | .012 | 3.657 | 1 |
.056
| 0.977 | 0.954 | 1.001 |
Number of pain-related other treatments in the last 6 months | −.003 | .007 | 0.200 | 1 | .655 | 0.997 | 0.982 | 1.011 |
Number of doctors involved because of pain | −.010 | .025 | 0.151 | 1 | .698 | 0.990 | 0.943 | 1.040 |
Number of pain-associated hospital visits | −.026 | .056 | 0.222 | 1 | .638 | 0.974 | 0.873 | 1.087 |
Number of pain-associated rehabilitations | .027 | .071 | 0.146 | 1 | .702 | 1.027 | 0.894 | 1.180 |
Retirement request pending | −.008 | .595 | 0.000 | 1 | .989 | 0.992 | 0.309 | 3.183 |
Current retirement payment | −.108 | .292 | 0.138 | 1 | .710 | 0.897 | 0.507 | 1.589 |
Disability request pending | .292 | .216 | 1.821 | 1 | .177 | 1.339 | 0.876 | 2.047 |
Work accident as reason for pain condition | −.083 | .422 | 0.038 | 1 | .845 | 0.921 | 0.402 | 2.107 |
Regression Coefficient β | Standard-error | Wald | df | p | OR | % Confidence Interval for OR | ||
---|---|---|---|---|---|---|---|---|
Lower Value | Upper Value | |||||||
Age | −.020 | .011 | 3.481 | 1 | .062 | 0.981 | 0.960 | 1.001 |
School education | .430 | .262 | 2.695 | 1 | .101 | 1.537 | 0.920 | 2.569 |
Pain perception affective (SES) | −.011 | .015 | 0.499 | 1 | .480 | 0.990 | 0.961 | 1.019 |
Lowest pain severity in the last 4 weeks | −.029 | .057 | 0.250 | 1 | .617 | 0.972 | 0.868 | 1.088 |
Highest pain severity in the last 4 weeks | .229 | .102 | 5.013 | 1 |
.025
| 1.257 | 1.029 | 1.535 |
Disability due to Pain (PDI) | .306 | .077 | 15.803 | 1 |
<.001
| 1.358 | 1.168 | 1.580 |
Mental-health-related quality of life (SF-36) | −.017 | .010 | 2.746 | 1 | .098 | 0.983 | 0.964 | 1.003 |
Number of pain-associated physician visits in the last six months | −.036 | .014 | 6.947 | 1 |
.008
| 0.965 | 0.939 | 0.991 |