[Therapeutic results in chronic, non-malignant pain in patients treated at a Danish multidisciplinary pain center compared with general practice. A randomized controlled clinical trial].

INTRODUCTION

Multidisciplinary pain treatment (MPT) is generally considered to be the most effective treatment of chronic pain, but its long-term effect has not yet been firmly established.

METHODS

This randomised controlled study compared the effect of outpatient MPT with that of treatment by general practitioners after initial supervision by a pain specialist (GP group) and with a six-month waiting list group (WL group). The participants were 189 patients with chronic non-malignant pain. On referral and at three and six months, the patients filled in questionnaires evaluating pain intensity, health-related quality of life (HRQL), and the use of analgesics.

RESULTS

At six months, the patients allocated to MPT (N = 63) reported a reduction in pain intensity (p < 0.001), and an improvement in psychological well-being (p < 0.001), quality of sleep (p < 0.05), and physical functioning (p < 0.05). The WL group (N = 63) had a statistically significant deterioration in most of the HRQL measures. The only effect of treatment found in the GP group was a reduction in the use of short-acting opioids. In the MPT group, the use of opioids administered on demand and short-acting opioids was decreased (p < 0.001). No change in the use of analgesics was seen in the WL group.

DISCUSSION

The study showed that (i) in the MPT group there was a significant reduction in pain intensity and an improvement in HRQL compared to the WL group, and (ii) the mere establishment of a pain diagnosis and management plan by a specialist was not sufficient to enable the referring GP to manage patients with severe chronic pain.