Mailis Angela, Deshpande Amol, Lakha S Fatima
Pain and Wellness Center, 2301 Major Mackenzie Drive West Unit 101, Vaughan, ON, L6A 3Z3, Canada.
Department of Medicine, University of Toronto, Toronto, L6A 3Z3, Canada.
J Patient Rep Outcomes. 2022 May 7;6(1):44. doi: 10.1186/s41687-022-00452-z.
Chronic pain management multi/interdisciplinary programs attempt to address all elements of the biopsychosocial model. The primary objective of this retrospective study (based on practice-based audit) was to determine the effectiveness of a patient-centered, comprehensive and intense interdisciplinary pain management program in a publicly funded community-based pain clinic in the Greater Toronto Area.
This retrospective longitudinal study was conducted on 218 carefully selected sequential chronic pain patients, with 158 completing a 3-4-month interdisciplinary program between January 2016 and December 2018. Data collected upon exit, at 6 months and 12 months post-discharge included demographic information, pain characteristics, emotional/functional status obtained by validated instruments and global impression of change (GIC). Additionally, social health outcomes (return to work or school) were retrieved through retrospective chart review. Means of pre-and post-program variables were compared to assess changes of each patient's "journey".
Physical and mental/ emotional health outcomes at exit, 6 months and 12 months post-discharge, showed initial and sustained, statistically and clinically significant improvement from pre-treatment levels, with GIC (much/very much improved) reported as 77%, 58% and 76%, respectively. Additionally, a substantial positive change in social health outcomes was noted particularly in patients on disability (29%), part time workers gaining full time employment (55%), and students (71%) who improved their level of schooling.
The study showed that careful patient selection in a community-based publicly funded interdisciplinary pain management program can produce significant improvement in pain, physical, mental/emotional health and social function, with sustained long-term outcomes.
慢性疼痛管理多学科/跨学科项目试图解决生物心理社会模型的所有要素。这项回顾性研究（基于实践审计）的主要目的是确定在大多伦多地区一个由公共资金资助的社区疼痛诊所中，以患者为中心、全面且强化的跨学科疼痛管理项目的有效性。
这项回顾性纵向研究针对218名精心挑选的连续慢性疼痛患者开展，其中158名患者在2016年1月至2018年12月期间完成了为期3 - 4个月的跨学科项目。出院时、出院后6个月和12个月收集的数据包括人口统计学信息、疼痛特征、通过有效工具获得的情绪/功能状态以及总体变化印象（GIC）。此外，通过回顾病历检索社会健康结局（重返工作或学校情况）。比较项目前后变量的均值，以评估每位患者“历程”的变化。
出院时、出院后6个月和12个月的身体和心理/情绪健康结局显示，与治疗前水平相比，有初始且持续的、具有统计学和临床意义的改善，GIC（改善很多/非常多）报告分别为77%、58%和76%。此外，社会健康结局有显著的积极变化，特别是在残疾患者（29%）、兼职工作者获得全职工作（55%）以及学业水平提高的学生（71%）中。
该研究表明，在基于社区的公共资金资助的跨学科疼痛管理项目中，仔细挑选患者可使疼痛、身体、心理/情绪健康和社会功能得到显著改善，并产生持续的长期效果。
