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ORIGINAL RESEARCH article
Front. Psychol.
Sec. Psychology for Clinical Settings
Volume 15 - 2024 |
doi: 10.3389/fpsyg.2024.1448117
This article is part of the Research Topic Optimizing the Therapeutic Potential in Clinical Settings: Leveraging Placebos and Mitigating Nocebo Effects View all articles
Interdisciplinary Pain Program participants with high catastrophizing scores improve function utilizing enriched therapeutic encounters and integrative health techniques: A retrospective study
Provisionally accepted- 1 Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Boston, Massachusetts, United States
- 2 Harvard Medical School, Boston, Massachusetts, United States
- 3 Spaulding Integrative Health Initiative, Spaulding Rehabilitation Hospital, Boston, United States
- 4 Pain & Functional Restoration Program, Spaulding Rehabilitation Hospital, Medford, MA, Medford, Massachusetts, United States
- 5 Department of Occupational Therapy, Spaulding Rehabilitation Hospital, Boston, MA, Boston, United States
- 6 Laboratory of Neuroimaging and Genetics, Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts, United States
- 7 Spaulding Research Institute, Spaulding Rehabilitation Hospital Network, Boston, MA, Boston, United States
- 8 Department of Occupational Therapy, MGH Institute of Health Professions, Boston, Massachusetts, United States
- 9 College of Human Medicine, Michigan State University, East Lansing, Michigan, United States
Pain catastrophizing describes helplessness, rumination, and magnification of a pain experience. High pain catastrophizing is an independent risk factor for disability, pain severity, inadequate treatment response, chronicity, and opioid misuse. Interdisciplinary pain programs (IPPs) are beneficial and cost-effective for individuals with chronic pain, but their functional impact on individuals with high pain catastrophizing is not well established. The emerging field of placebo studies suggests that patient-provider relationships, positive treatment expectations, and sociobiologically informed care trigger physiological responses that may enhance therapeutic interventions. In this retrospective observational cohort study, we compared admission and discharge data for 428 adults with high-impact chronic pain (mean 8.5 years) who completed the Spaulding-Medford Functional Restoration Program (FRP). The interdisciplinary FRP team of physiatrists, behavioral health clinicians, physical therapists, and occupational therapists specializes in evidencedbased conventional rehabilitation, integrative health, and pain psychoeducation via enriched therapeutic encounters, fostering collaboration, validation, trust, self-efficacy, and positive expectations. Clinical outcome measures included the Canadian Occupational Performance Measure (COPM) assessing functional performance (COPM-PS) and satisfaction with function (COPM-SS), the Pain Numeric Rating Scale (NRS), the Pain Catastrophizing Scale (PCS), and the Patient Health Questionnaire-9 (PHQ-9). FRP participants with clinically elevated catastrophizing at baseline (PCS >30, mean PCS 39) achieved statistically significant improvements in function (mean delta -2.09, CHI2=15.56, p<0.001), satisfaction with function (COPM-SS mean delta -2.50, CHI2= 7.42, p= 0.007), pain (NRS mean delta 2.7), mood (PHQ-9 mean delta 1.87, p=0.002), and catastrophizing (PCS mean delta 4.16, p<0.001). Subgroup analysis revealed racial disparities in pain scores, and exploratory analysis showed a trend toward reducing opiate consumption. Despite the known association of adverse outcomes with high catastrophizing, FRP participation was associated with increased productive engagement, reduced pain, reduced maladaptive thought processes, and improved mood. Although causation and efficacy cannot be established from a retrospective design, this is the first study to identify functional improvement in patients with high-impact chronic pain and clinically relevant high pain catastrophizing who participate in an IPP combining conventional and complementary rehabilitation with psychoeducation. These enriched therapeutic encounters may enhance the treatment process by promoting trust, empathy, collaboration, and beneficial reframing of patients' experiences, expectations, and goals.
Keywords: Pain catastrophizing, functional outcomes, Chronic Pain, Interdisciplinary/Multidisciplinary Pain Management Programs, Integrative health
Received: 17 Jun 2024; Accepted: 28 Aug 2024.
Copyright: © 2024 Vora, Kennedy-Spaien, Gray, Estudillo Guerra, Phillips Otr, Mesia-Toledo, Glenn, Chin and Morales-Quezada. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence:
Ariana Vora, Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Boston, 02129, Massachusetts, United States
Leon Morales-Quezada, Spaulding Integrative Health Initiative, Spaulding Rehabilitation Hospital, Boston, United States
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