Abstracts (316) Acceptance and values-based action in chronic pain: an analysis of treatment outcomes and processes three years after treatment completion K Vowles, L McCracken, and J Zhao-O’Brien; Royal National Hospital for Rheumatic Diseases, Bath, UK There is increasing evidence to support the role of acceptance and values as key processes in the treatment of chronic pain. Thus far, nine trials have been published which indicate treatments targeting these two processes result in decreased interference from pain, less distress and disability, and generally improved functioning. Challenges in the evidence base remain, such as the question of longer term effects of treatment, as existing trials have been limited to follow-up intervals of less than nine months. The present study examines results of a follow-up assessment occurring three year after treatment in a cohort of 171 completers of an interdisciplinary treatment program. It also examines the contribution of acceptance and values-based action to these results. Within group comparisons showed that patients who provided data at the three-year follow-up reported significantly lower levels of physical and psychosocial disability, depression, pain-related anxiety, and healthcare utilization in comparison to the start of treatment. There was evidence for maintenance of treatment gains relative to an earlier follow-up three months post-treatment in that almost all effect sizes relative to treatment onset remained at a medium or large level at the three year follow-up. The percentage of patients whose work status was affected by pain dropped from 74.9% at pre-treatment to 39.9% at the three-year follow-up. Levels of pain acceptance and values-directed action, two of the key treatment processes, were also significantly increased, and these improvements were significantly linked to improvements across the majority of outcome measures. These analyses provide evidence for the effectiveness of treatment over the longer term. Furthermore, they suggest that a specifically process-oriented intervention is effective at changing the behaviour of those suffering from chronic pain and that these changes are generally maintained three years following treatment completion. This abstract will also be presented as an Oral Paper Presentation on May 8. Refer to the daily Schedule-At-A-Glance for presentation time and location.
(317) Post-deployment multi-symptom disorder: an integrated behavioral health approach to treatment M Bosco, R Walker, M Clark, and S Takagishi; James A. Haley VA Hospital, Tampa, FL A substantial percentage of returning Operation Enduring Freedom/Operation Iraqi Freedom veterans and active duty service members present to VA treatment programs with what has been labeled Post-deployment Multi-symptom Disorder (PMD), which consists of multiple co-morbid symptoms of Pain, Post Concussive Syndrome (PCS), Post Traumatic Stress Disorder (PTSD), and substance use disorders (SUD). Results of studies investigating this symptom constellation suggest a high prevalence of pain, high rates of co-morbid cognitive and mental health disorders, and significant symptom overlap between these conditions. Clinical impressions and some limited empirical data suggest that PMD symptoms do not respond as well to traditional single diagnosis treatment programs. As an alternative, we describe a model of PMD treatment based on an innovative integrated behavioral health approach that was developed at a large southeastern VA medical center. This program is staffed by a multidisciplinary team (psychology, psychiatry, PT, nursing) with advanced knowledge of Pain, PCS, PTSD, and SUD. The goals of the program are to efficiently and effectively deliver symptomatic and preventive behavioral health care on an intensive outpatient basis to veterans and service members experiencing functional impairment in multiple life roles due to PMD. The program consists of core and focused treatments utilizing cognitive-behavioral, rehabilitative, and activation strategies designed to reduce overlapping PMD symptoms, improve functioning, and prevent further decline. Implications concerning the effectiveness of this integrated care approach, as well as its potential applicability to civilian patient populations with pain conditions are discussed.
S55 (318) Return to work prescription increases return to work rate in a primarily Hispanic population with chronic pain J Monsivais, D Monsivais, and K Robinson; Hand and Microsurgery Center of El Paso, El Paso, TX Managing expectations about returning to work is an important component of recovery for patients with chronic neuropathic pain syndromes. Sensory and motor recovery were used instead of pain levels to determine the return to work date for a primarily Hispanic population with chronic neuropathic pain. An archival review was carried out of 91 patients treated for neuropathic pain who had extreme difficulty in managing pain syndromes. The patients were treated in a specialty clinic over a 10 year period. All patients received a prescription to return to work based on sensory and motor recovery, care based on best-identified pain management practices, periodic pain assessment, clinical evaluation of sensory and motor function, plus pharmacological pain management. Prior to the onset of the painful condition 93.4% of patients were employed, and 6.6% were unemployed. At the time of the psychologist visit, about 46% were employed and 64% were unemployed. At the last surgical follow-up visit, 93.4% were employed and 6.6% were unemployed, which was the same as prior to the onset of the painful condition. The posttreatment return to work rate is higher than reported in the literature, and patients remained at work more than 5 years after the onset of the nerve injury. Creating the expectation early in treatment that return to work is part of the process and basing the return to work date on sensory and motor recovery increased the rate of return to work. Psychosocial assessment, support and pain management based on best practices influence the ability of patients to return to work regardless of surgical/non-surgical treatment options.
(319) painACTION.com: An interactive self-management website for chronic back pain patients E Chiauzzi, L Pujol, K Zacharoff, K Bond, E Yiu, M Wood, and R Black; Inflexxion, Inc., Newton, MA The Internet can assist back pain patients in developing self-management skills, but available pain websites offer few interactive self-management strategies or focus on selling products. The aim of this poster is to describe the development and testing of an interactive website called painACTION.com. This randomized, controlled trial examined the hypotheses that, relative to a control condition, painACTION.com participants would report significant improvements in pain, physical functioning, emotional functioning, coping, and selfefficacy. The conditions included Experimental (eight site visits in a month plus 5 monthly boosters) and Control (treatment as usual) groups. Experimental participants were also classified as high dose and low dose based on a median split. Measures (pain, daily functioning, catastrophizing, self-efficacy, pain beliefs, emotional functioning, and work productivity) were administered at baseline, post-intervention, and three- and six-month follow-ups. Experimental participants showed decreased stress over all time points. Experimental participants with high baseline pain increased relaxation, decreased guarding, and decreased helplessness. Experimental participants recruited online evidenced decreased average pain ratings, increased coping self-statements, and decreased worst pain levels. High-dose participants showed increased coping self-statements and decreased stress. The Internet offers a potentially effective vehicle for enhancing self-management in back pain patients. Findings suggest better outcomes with a less severe (lower disability) group online compared to a clinic population. Also, participants with higher baseline pain levels and those at higher website dosages responded better to the website intervention. (The development of painACTION.com was funded by SBIR Grant #9R44DA022802-02 from the National Institute on Drug Abuse; its ongoing maintenance is funded by unrestricted grants from Endo Pharmaceuticals and King Pharmaceuticals.)