Gillman Andrea, Zhang Di, Jarquin Susan, Karp Jordan F, Jeong Jong-Hyeon, Wasan Ajay D
UPMC Pain Medicine, Pittsburgh, Pennsylvania.
Department of Anesthesiology and Perioperative Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania.
Pain Med. 2020 May 1;21(5):978-991. doi: 10.1093/pm/pnz294.
Embedded behavioral medicine services are a common component of multidisciplinary chronic pain treatment programs. However, few studies have studied whether these services are associated with improved treatment outcomes.
Using a retrospective, matched, two-cohort study design, we examined patient-reported outcomes (PROs), including Patient-Reported Outcomes Measurement Information System pain, mental health, and physical function measures, collected at every clinic visit in every patient. Changes from baseline through 12 months were compared in those receiving embedded Behavioral Medicine in addition to usual care to a Standard Care group seen in the same pain practice and weighted via propensity scoring.
At baseline, Behavioral Medicine patients had worse scores on most pain, mental health, and physical health measures and were more likely to be female, a member of a racial minority, and have lower socioeconomic status. Regardless of having a worse clinical pain syndrome at baseline, at follow-up both Behavioral Medicine (N = 451) and Standard Care patients (N = 8,383) showed significant and comparable improvements in pain intensity, physical function, depression, and sleep disturbance. Behavioral Medicine patients showed significantly greater improvements in their global impressions of change than the Standard Care patients.
Despite worse pain and physical and psychological functioning at baseline, Behavioral Medicine patients showed improvements comparable to patients not receiving these services. Further, Behavioral Medicine patients report higher global impressions of change, indicating that embedded mental health services appear to have the additive value of amplifying the benefits of multimodal pain care.
嵌入式行为医学服务是多学科慢性疼痛治疗项目的常见组成部分。然而，很少有研究探讨这些服务是否与改善治疗结果相关。
采用回顾性、匹配的双队列研究设计，我们检查了患者报告的结局（PROs），包括患者报告结局测量信息系统的疼痛、心理健康和身体功能测量指标，这些指标在每位患者的每次门诊就诊时收集。将接受常规护理加嵌入式行为医学治疗的患者与同一疼痛治疗机构中接受标准护理的对照组进行比较，比较从基线到12个月的变化，并通过倾向评分进行加权。
在基线时，行为医学组患者在大多数疼痛、心理健康和身体健康指标上得分更低，更有可能是女性、少数族裔成员，且社会经济地位较低。尽管基线时临床疼痛综合征更严重，但在随访时，行为医学组（N = 451）和标准护理组（N = 8383）在疼痛强度、身体功能、抑郁和睡眠障碍方面均有显著且相当的改善。行为医学组患者对变化的总体印象改善程度明显高于标准护理组患者。
尽管行为医学组患者在基线时疼痛以及身体和心理功能更差，但与未接受这些服务的患者相比，他们的改善程度相当。此外，行为医学组患者报告的变化总体印象更高，这表明嵌入式心理健康服务似乎具有增强多模式疼痛护理益处的附加价值。
