Authors' objectives: Two main questions were addressed in this report: 1. What is the strength of the evidence on the efficacy/effectiveness of multidisciplinary pain programs (MPPs) for patients with chronic pain (CP)? 2. What is the evidence on the efficiency of MPPs for treating CP patients?

Authors' recommendations: The approach taken to evaluate the current published scientific evidence on the efficacy, effectiveness and economic consequences of multidisciplinary pain programs (MPPs) for patients with chronic pain (CP) not related to cancer, was to analyze and synthesize the findings from systematic reviews (SRs) including meta-analyses. Given the cost and consequences of CP, whether MPPs are therapeutically and financially effective are important issues of consideration. MPPs in this report are defined as being a comprehensive approach that involves coordinated interventions among a variety of disciplines working together in the same facility in an integrated way with joint goals and with ongoing communication. The patient is considered to be an active participant who assumes significant responsibility within the rehabilitation process with the staff playing a teaching and consulting role. The rationale for MPPs as a therapeutic approach is to provide simultaneous assessment and management of somatic, behavioural and psychosocial components of CP. MPPs aim to improve quality of life outcomes, to increase patient independence and to restore physical, psychological, social, and occupational functioning. Treatment strategies available at MPPs usually vary from centre to centre in terms of the setting (inpatient versus outpatient), number of hours and days involved, and type, intensity, and nature of treatment modalities offered. Patients seen at MPPs are often not representative of all those with CP and alternatively, not all CP patients should attend MPPs. As tertiary centres, MPPs are generally selected for patients with complex and long-standing pain problems. From the twelve SRs on the effectiveness of MPPs, five met the inclusion criteria. Four of these SRs focused on MPPs as the primary intervention of interest, whereas one SR considered MPPs among several other interventions. The results from a recent good quality SR tend to support the effectiveness of intensive MPPs for chronic low back pain patients in terms of their effects on functional improvement and pain reduction. The results from one clinical trial included in one of the SRs support the use of MPPs in patients with chronic pelvic pain in terms of daily activity level and self-rating scales. The other SRs found limited evidence and therefore the findings were considered to be inconclusive regarding the effectiveness of MPPs in managing CP in other conditions such as fibromyalgia and widespread musculoskeletal pain, and shoulder and neck pain. From the five SRs on the efficiency of MPPs, only one met the inclusion criteria. The authors of this good quality SR concluded that it was not possible to answer the question on whether MPPs are cost effective or not. They noted a lack of economic evaluations within the published research on multidisciplinary management of CP. A standardized operational definition for a MPP is essential to ensure that future program comparisons or evaluations are possible to answer the challenging questions such as which treatment/management strategies are effective, for which patient group and at what costs. There is a need for research on the various aspects of the multidisciplinary approach. Regional Health Authorities providing MPPs for the management of CP not related to cancer need to conduct appropriate evaluations. Because the programs vary so much in the specific techniques used to manage pain, little is known about which treatment or set of treatments is responsible for the observed improvements or which kind of patients do best under a particular form of individualized treatment plan. Maintaining and monitoring outcome data systems should be a top priority for any MPP.

Authors' methods: Systematic review

Project Status: Completed

Year Published: 2003

URL for published report: http://www.ihe.ca/advanced-search/multidisciplinary-pain-programs-for-chronic-pain-evidence-from-systematic-reviews

English language abstract: An English language summary is available

Publication Type: Not Assigned

Country: Canada

Organisation Name: Institute of Health Economics

Contact Address: 1200, 10405 Jasper Avenue, Edmonton, Alberta, Canada, T5J 3N4. Tel: +1 780 448 4881; Fax: +1 780 448 0018;

Contact Name: djuzwishin@ihe.ca

Contact Email: djuzwishin@ihe.ca

Copyright: <p>Alberta Heritage Foundation for Medical Research (AHFMR)</p>