Biopsychosocial baseline values of almost 15 000 patients ...
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Biopsychosocial baseline values of almost 15 000 patients suffering from chronic pain; the Dutch DATAPAIN study Brigitte Brouwer, Sophie Waardenburg, Christian Jacobs, Marjori Overdijk, Carsten Leue, Albère Köke,Sander MJ van Kuijk, Maarten van Kleef, Jan van Zundert, Nelleke de Meij Background and objectives Chronic pain affects many adults. To improve our daily practice, we need to understand multidisciplinary approaches, integrated treatment plans, and the biopsychosocial context of these patients. To date, almost 15,000 chronic pain patients have been referred to the Maastricht University Pain Center in the Netherlands. Methods This study describes 11,214 of these patients suffering from chronic pain. Patients provided informed consent, and ethical clearance was obtained from the medical ethical committee (METC). Chronic pain was analyzed using relevant IMMPACT instruments. Results Most patients were female (59.3%). The prevalence of low education was 59%, and unemployment/disability was 35.9%. Mean age was 55.6 years. Severe pain (NRS 7-10) was reported by 71.9% of the patients; psychological and quality of life values deteriorated when pain severity increased. Approximately 36% of patients showed severe signs of depression or anxiety, and 39% displayed high pain catastrophizing. Of all patients, 17.8% reported high values for pain severity, catastrophizing, and anxiety or depression (Fig. 1). Conclusions Based on baseline biopsychosocial values, this study shows the complexity of patients referred to pain centers. Pain management with a biopsychosocial approach in an integrated multidisciplinary setting is indispensable. Above all, adjusted education on chronic pain and attention to its biopsychosocial aspects are deemed necessary. Fig. 1. Of all patients, 17.8 % reported high values on the NRS (7-10), depression or anxiety (>10), and pain PCS (>31) scales. There were significant differences in patient characteristics (sex: P =.018, age: P =.001, marital status: p=.001, education: p=.001, multisite pain: p=.001,) and quality of life values between ‘complex groups’ versus ‘not complex’ groups Corresponding author: [email protected] Accepted for publication: Reg Anesth Pain Med. 2020 Oct; 45 (10): 774-782 BPI-REM BPI-WAW BPI-Interference Complex group 20,8 30,4 51,2 Non-complex group 10,3 22,5 32,8 0 10 20 30 40 50 60 70 Brief Pain Inventory NRS Anxiety (HADS) Depression (HADS) HADS total PCS Complex group 8,4 12,5 12,6 25,1 41,4 Non-complex group 6,8 6,5 6,6 13,1 23,6 Complete interference No interference PHS MHS Complex group 28,4 31,5 Non-complex group 31,6 45,9 0 10 20 30 40 50 60 70 80 90 100 Quality of life (RAND 36/SF12) Complex group = 17.8 % (n=1859) of the patients with high values on NRS (7-10), anxiety or depression (>10), and PCS (>31) Logistic regression P .001 Logistic regression P .001 Reference value = < 50 worse quality of life, > 50 better quality of life then the average Dutch population 0 = does not interfere – 10 complete interference,. BPI WAW = walking, general activity, work and sleep. Max score 40 BPI REM= relations with others, enjoyment of life, and mood. Max score 30 BPI Interference = sum of seven questions. Max score 70 Fig. 1 Complex group versus non-complex group University Pain Centre Maastricht, UPCM, Department of Anesthesiology and Pain Medicine, Department of Psychiatry and Psychology, MUMC+, Department of Rehabilitation Medicine/CAPHRI, School for Public Health and Primary Care, UM, the Netherlands. Adelante Centre of Expertise in Rehabilitation and Audiology, Hoensbroek, the Netherlands. Zuyd University for Applied Sciences, Faculty of Health and Technology, Heerlen, the Netherlands. Department of Clinical Epidemiology and Medical Technology Assessment, MUMC+, the Netherlands. Department of Anesthesiology and Multdisciplinary Paincentre Ziekenhuis Oost Limburg, Genk/Lanaken, Belgium
Transcript of Biopsychosocial baseline values of almost 15 000 patients ...
Biopsychosocial baseline values of almost 15 000 patients suffering from chronic pain; the Dutch DATAPAIN study
Brigitte Brouwer, Sophie Waardenburg, Christian Jacobs, Marjori Overdijk, Carsten Leue, Albère Köke, Sander MJ van Kuijk, Maarten van Kleef, Jan van Zundert, Nelleke de Meij
Background and objectives
Chronic pain affects many adults. To improve our daily practice, we need to understand
multidisciplinary approaches, integrated treatment plans, and the biopsychosocial context
of these patients. To date, almost 15,000 chronic pain patients have been referred to the
Maastricht University Pain Center in the Netherlands.
Methods
This study describes 11,214 of these patients suffering from chronic pain. Patients provided
informed consent, and ethical clearance was obtained from the medical ethical committee
(METC). Chronic pain was analyzed using relevant IMMPACT instruments.
Results
Most patients were female (59.3%). The prevalence of low education was 59%, and
unemployment/disability was 35.9%. Mean age was 55.6 years. Severe pain (NRS 7-10) was
reported by 71.9% of the patients; psychological and quality of life values deteriorated
when pain severity increased. Approximately 36% of patients showed severe signs of
depression or anxiety, and 39% displayed high pain catastrophizing. Of all patients, 17.8%
reported high values for pain severity, catastrophizing, and anxiety or depression (Fig. 1).
Conclusions
Based on baseline biopsychosocial values, this study shows the complexity of patients
referred to pain centers. Pain management with a biopsychosocial approach in an
integrated multidisciplinary setting is indispensable. Above all, adjusted education on
chronic pain and attention to its biopsychosocial aspects are deemed necessary.
Fig. 1. Of all patients, 17.8 % reported high values on the NRS (7-10), depression or anxiety (>10), and pain PCS (>31) scales. There
were significant differences in patient characteristics (sex: P =.018, age: P =.001, marital status: p=.001, education: p=.001, multisite
pain: p=.001,) and quality of life values between ‘complex groups’ versus ‘not complex’ groups
Corresponding author: [email protected] for publication: Reg Anesth Pain Med.
2020 Oct; 45 (10): 774-782
BPI-REM BPI-WAW BPI-InterferenceComplex group 20,8 30,4 51,2Non-complex group 10,3 22,5 32,8
0
10
20
30
40
50
60
70
Brief Pain Inventory
NRS Anxiety (HADS) Depression (HADS) HADS total PCSComplex group 8,4 12,5 12,6 25,1 41,4Non-complex group 6,8 6,5 6,6 13,1 23,6
Complete interference
No interference
PHS MHSComplex group 28,4 31,5Non-complex group 31,6 45,9
0102030405060708090
100Quality of life (RAND 36/SF12)
Complex group = 17.8 % (n=1859)
of the patients with high values on
NRS (7-10), anxiety or depression
(>10), and PCS (>31)
Logistic regression P .001 Logistic regression P .001
Reference value = < 50 worse quality of life, > 50 better quality of life then the average Dutch population
0 = does not interfere – 10 complete interference,.BPI WAW = walking, general activity, work and sleep. Max score 40 BPI REM= relations with others, enjoyment of life, and mood. Max score 30BPI Interference = sum of seven questions. Max score 70
Fig. 1 Complex group versus non-complex group
University Pain Centre Maastricht, UPCM, Department of Anesthesiology and Pain Medicine, Department of Psychiatry and Psychology, MUMC+, Department of Rehabilitation Medicine/CAPHRI, School for Public Health and Primary Care, UM, the Netherlands. Adelante
Centre of Expertise in Rehabilitation and Audiology, Hoensbroek, the Netherlands. Zuyd University for Applied Sciences, Faculty of Health and Technology, Heerlen, the Netherlands. Department of Clinical Epidemiology and Medical Technology Assessment, MUMC+, the
Netherlands. Department of Anesthesiology and Multdisciplinary Paincentre Ziekenhuis Oost Limburg, Genk/Lanaken, Belgium
