What is the Role of Decision Making and Patient Choice on Chronic Pain Patientsí Psychological Well-being During a Residential Chronic Pain Management Programme?
Authors: Amy Cowburn, Jared G Smith, Lucie Knight and Nicole Jamani
Abstract: A new referral-to-treatment care pathway was introduced onto a multidisciplinary pain management programme (PMP) in order to provide patients with more pre-programme information, make assessment more multidisciplinary, and allow a stronger patient role in the treatment process. The impact of the new pathway on patientsí psychological function at programme entry and on change across the programme was investigated via a comparison of outcomes with the previous care pathway, using measures of depression, pain catastrophising, pain self-efficacy, and kinesiophobia. The old care pathway (CP1) was represented by a sample of 79 chronic pain patients who were assessed by a medical consultant and a psychologist before completing a pre-treatment appointment prior to PMP attendance. Under the new care pathway (CP2), 80 chronic pain patients were assessed by a medical consultant. This was followed by an educational information-giving session, a patient-led opt-in/opt-out procedure, and (after opting-in) a multidisciplinary assessment before attending the PMP. Comparisons between the care pathways revealed significant pre-PMP benefits for patients in CP2 in pain self-efficacy levels. However, this difference did not manifest itself into a better outcome post-PMP. Rather, while both groups demonstrated substantial benefits from programme completion, post-PMP function was highly comparable between pathway groups on all measures. In terms of improving chronic pain patientsí psychological function both before and after a PMP, better informing patients as to the nature of potential treatment and permitting them to opt-in to or opt-out of treatment appears to be no more effective than giving patients limited information and less choice.