Evaluation of treatment with Cognitive therapy and a patient-centered approach in patients with chronic musculoskeletal pain and psychiatric co-morbidity – A pilot study

• Objective. The aim was to evaluate Cognitive therapy (CT) and a patient-centered-approach in a group of patients with chronic pain and psychiatric co-morbidity in relation to pain, dysfunction, anxiety, depression, burnout and health related quality of life (HRQoL). Design. Pilot study. Setting. Consulting psychiatry. Participants 30 consecutive patients with chronic pain, who had not responded to conventional pain treatment, were recruited during a period of 21 months. Interventions. All patients were offered treatment with cognitive therapy (CT). Twenty patients accepted treatment with CT and 13 patients, the therapy group, completed therapy. The no therapy group consisted of 7 patients who did not complete therapy and 10 patients who were only followed-up at monthly intervals. Main otutcome measures. Patient reported outcome measures (PROM) were administered at baseline and at follow-up after 8-11 months. PROM included Relationship Scales Questionnaire (RSQ ) for attachment pattern, Sense of coherence (SOC), Multidimensional Pain Inventory (MPI) for pain and dysfunction, Beck Anxiety Inventory (BAI), Beck Depression Inventory (BDI), Pines´scale for burnout and Short-Form 36 (SF-36). Statistical tests were conducted at a 5% significance level. Subgroup identification was accomplished by means of Multivariate data analysis (MVDA). Results. At the individualized follow-up the patients (n=25) reported significant improvement of Bodily Pain and Mental Health in Short-Form 36 ( SF-36), life control in MPI, depression, anxiety and SOC. There was a correlation between completed treatment with CT and improvement. Explorative modellings with MVDA suggested that patients with chronic pain and fearful attachment pattern had a better outcome than patients with preoccupied attachment pattern if they were treated with CT. Conclusion.. A patient-centered approach in combination with CT was beneficial for patients with chronic pain and psychiatric co-morbidity. MVDA indicated that the outcome of treatment may differ according to individual vulnerability and severity of burnout, depression and pain interference. Strengths and limitations of the study * This study is a small hypothesis generating pilot study and the results need to be followed up with larger randomized studies. *Patients who dropped out from therapy were followed in the no therapy group * The same therapist/physician (BP) treated the entire group. * In order to compensate for many variables and a limited number of observations explorative modellings with MVDA were performed.

Ämnesord

MEDICIN OCH HÄLSOVETENSKAP  -- Klinisk medicin (hsv//swe)

MEDICAL AND HEALTH SCIENCES  -- Clinical Medicine (hsv//eng)

Nyckelord

Chronic pain

Attachment pattern

Sense of Coherence

Subgroups in Multidimensional Pain Inventory (MPI)

Cognitive therapy

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