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The importance of emotional distress, cognitive behavioural factors and pain for life impact at baseline and for outcomes after rehabilitation - a SQRP study of more than 20,000 chronic pain patients
Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Pain and Rehabilitation Center.ORCID iD: 0000-0002-4316-1264
Skane Univ Hosp, Sweden; Lund Univ, Sweden.
Umea Univ, Sweden.
Danderyd Hosp, Sweden.
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2019 (English)In: Scandinavian Journal of Pain, ISSN 1877-8860, E-ISSN 1877-8879, Vol. 19, no 4, p. 693-711Article in journal (Refereed) Published
Abstract [en]

Background and aims: Although literature concerning chronic pain patients indicates that cognitive behavioural variables, specifically acceptance and fear of movement/(re)injury, are related to life impact, the relative roles of these factors in relation to pain characteristics (e.g. intensity and spreading) and emotional distress are unclear. Moreover, how these variables affect rehabilitation outcomes in different subgroups is insufficiently understood. This study has two aims: (1) to investigate how pain, cognitive behavioural, and emotional distress variables intercorrelate and whether these variables can regress aspects of life impact and (2) to analyse whether these variables can be used to identify clinically meaningful subgroups at baseline and which subgroups benefit most from multimodal rehabilitation programs (MMRP) immediately after and at 12-month follow-up. Methods: Pain aspects, background variables, psychological distress, cognitive behavioural variables, and two life impact variables were obtained from the Swedish Quality Registry for Pain Rehabilitation (SQRP) for chronic pain patients. These data were analysed mainly using advanced multivariate methods. Results: The study includes 22,406 chronic pain patients. Many variables, including acceptance variables, showed important contributions to the variation in clinical presentations and in life impacts. Based on the statistically important variables considering the clinical presentation, three clusters/subgroups of patients were identified at baseline; from the worst clinical situation to the relatively good situation. These clusters showed significant differences in outcomes after participating in MMRP; the subgroup with the worst situation at baseline showed the most significant improvements. Conclusions: Pain intensity/severity, emotional distress, acceptance, and life impacts were important for the clinical presentation and were used to identify three clusters with marked differences at baseline (i.e. before MMRP). Life impacts showed complex relationships with acceptance, pain intensity/severity, and emotional distress. The most significant improvements after MMRP were seen in the subgroup with the lowest level of functioning before treatment, indicating that patients with complex problems should be offered MMRP.

Place, publisher, year, edition, pages
WALTER DE GRUYTER GMBH , 2019. Vol. 19, no 4, p. 693-711
Keywords [en]
anxiety; acceptance; control; depression; distress; fear; mood; interference; pain
National Category
Applied Psychology
Identifiers
URN: urn:nbn:se:liu:diva-161625DOI: 10.1515/sjpain-2019-0016ISI: 000489140000007PubMedID: 31150362OAI: oai:DiVA.org:liu-161625DiVA, id: diva2:1367895
Note

Funding Agencies|Swedish Research Council, County Council of Ostergotland (Research-ALF); AFA insurance

Available from: 2019-11-05 Created: 2019-11-05 Last updated: 2020-04-27

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Gerdle, BjörnEnthoven, PaulDong, Huan-Ji
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