The Resurrection of Interdisciplinary Pain Rehabilitation: Outcomes Across a Veterans Affairs Collaborative.

Autor:	Murphy JL; James A. Haley Veterans' Hospital, Tampa, Florida, USA.; University of South Florida Morsani College of Medicine, Tampa, Florida, USA., Palyo SA; San Francisco VA Health Care System, San Francisco, California, USA.; University of California, San Francisco, California, USA., Schmidt ZS; New Mexico VA Health Care System, Albuquerque, New Mexico, USA., Hollrah LN; VA Puget Sound Health Care System, Tacoma, Washington, USA., Banou E; James A. Haley Veterans' Hospital, Tampa, Florida, USA., Van Keuren CP; VA Northeast Ohio Healthcare System, Cleveland, Ohio, USA., Strigo IA; San Francisco VA Health Care System, San Francisco, California, USA.; University of California, San Francisco, California, USA.
Jazyk:	angličtina
Zdroj:	Pain medicine (Malden, Mass.) [Pain Med] 2021 Feb 23; Vol. 22 (2), pp. 430-443.
DOI:	10.1093/pm/pnaa417
Abstrakt:	Objective: Despite empirical support for interdisciplinary pain rehabilitation programs improving functioning and quality of life, access to this treatment approach has decreased dramatically over the last 20 years within the United States but has grown significantly in the Department of Veterans Affairs (VA). Between 2009 and 2019, VA pain rehabilitation programs accredited by the Commission on Accreditation of Rehabilitation Facilities increased 10-fold in the VA, expanding from two to 20. The aim of this collaborative observational evaluation was to examine patient outcomes across a subset of six programs at five sites. Methods: Outcomes were assessed using agreed-upon measures of patient-reported pain intensity, pain interference across various domains, pain catastrophizing, and sleep. Results: A total of 931 patients enrolled in the selected VA interdisciplinary pain programs, with 84.1% of participants completing the full course of treatment. Overall, all programs showed significant improvements from pretreatment to posttreatment in nearly all patient-reported outcomes. The effect sizes ranged from medium to large. Notably, the results demonstrate that positive outcomes were typical despite differences in structure and resources across programs. Conclusions: The adverse impacts of opioid use have highlighted the importance of chronic pain treatment approaches that emphasize team-based care focused on functional improvements. This study represents the first and largest analysis of outcomes across chronic pain rehabilitation programs and demonstrates the need for increased access to similar comprehensive approaches to pain management across the health care system. Further, it suggests that a variety of structures may be effective, encouraging flexibility in adopting this interdisciplinary approach. (Published by Oxford University Press on behalf of the American Academy of Pain Medicine.)
Databáze:	MEDLINE
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