Highlights
- •Three pain response trajectories emerged: responder, late responder and nonresponder.
- •The strongest predictor of pain nonresponse was lower readiness to change.
- •The social milieu benefits patients with social difficulties.
- •Targeted treatment of key factors could maximize responsivity.
Abstract
Intensive pain rehabilitation programs for children with chronic pain are effective
for many patients. However, characteristics associated with treatment response have
not been well documented. In this article we report trajectories of pain and functional
impairment in patients with chronic pain up to 1 year after intensive pain rehabilitation
and examine baseline factors associated with treatment response. Patients (n = 253)
with chronic pain and functional disability were assessed at 5 time points (admission,
discharge, 1-month, 4-month, and 12-month follow-ups). Individual trajectories were
empirically grouped using SAS PROC TRAJ. For functional disability, 2 groups emerged:
treatment responders (88%) and nonresponders (12%). Using a binomial logistic regression
model to predict disability trajectory group, no baseline variables were significant
predictors for the disability trajectory group. For pain, 3 groups emerged: early
treatment responders (35%), late treatment responders (38%), and nonresponders (27%).
Using multinomial regression analyses to predict pain trajectory group, older age,
higher pain scores, fewer social difficulties, higher anxiety levels, and lower readiness
to change were characteristics that distinguished nonresponders from responders; no
significant predictors distinguished the late responders from the early responders.
These results provide key information on the baseline factors that influence intensive
pain rehabilitation outcomes, including risk factors that predict treatment nonresponse.
Our findings have implications for developing more targeted treatment interventions.
Perspective
Deriving groups of individuals with differing treatment response trajectories stimulates
new thinking regarding potential mechanisms that may be driving these outcomes.
Key words
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Article info
Publication history
Published online: November 01, 2017
Accepted:
October 17,
2017
Received in revised form:
October 17,
2017
Received:
December 16,
2016
Footnotes
This study were supported by a National Institutes of Health grant (K23 HD067202) awarded to L.E.S., a Boston Children's Hospital Office of Faculty Development Career Development Grant, and a National Institutes of Health grant (K23 GM123372-01) awarded to C.B.S., a National Institute of Neurological Diseases and Stroke grant (K24NS064050) awarded to D.B., the Sara Page Mayo Endowment for Pediatric Pain Research and Treatment, and the Department of Anesthesiology, Perioperative and Pain Medicine at Boston Children's Hospital.
The authors have no conflicts of interest to declare.
Identification
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© 2017 by the American Pain Society
