Chronic pain management in a health maintenance organization.

OBJECTIVE

The purpose of this study is to investigate the management of chronic pain in a large health maintenance organization using cognitive-behavioral techniques and a blinded control group.

DESIGN

Subjects were randomized into two groups. All participants completed a self-administered baseline questionnaire and were mailed a self-administered 6-month follow-up questionnaire.

SETTING

This study examines chronic pain management in a large, established health maintenance organization.

PATIENTS

Patients were members of a health maintenance organization, had pain for at least 6 months, and had failed all known treatment regimens.

INTERVENTIONS

The treatment group participated in a 16-hour, 8-week class teaching cognitive-behavioral techniques, the relaxation response, meditation, and stress management. The minimal treatment group received a home-study manual.

OUTCOME MEASURES

Behavioral outcomes, function, and pain severity and also patient satisfaction were measured.

RESULTS

Both the treatment and minimal treatment groups exhibited improvement in pain severity, negative mood, pain affect, and pain interference with the patient's life.

CONCLUSION

Gains were achieved in pain severity, negative mood, pain affect, self-control, and pain interference with the patient's life. Other behavioral variables and activity did not improve. Except in self-control, pain affect, and distracting responses from their significant others, the blinded minimal treatment group demonstrated similar findings. Patient satisfaction with treatment strongly favored the treatment group with over 78% of the treatment participants satisfied with the care provided.