Authors' objectives:

The author aims to determine whether in-patient pain management centres that adopt a behavioural approach confer any benefit over out-patient therapy that adopt similar practices.

Authors' results and conclusions: The 9-18 month follow-up of the first RCT found an increased number of patients were using medication appropriately and a bigger proportion had increased their activity levels, while controls had worsened on both these indicators; but these results must be interpreted with scepticism as the randomisation process was not successful and treated groups were shown to be significantly different pre-treatment. One month into the other RCT, greatest improvement differences were found in physical measures with stair climbing ability, sit ups and walking distance all increased by between a third and a half over similar measures tested on out-patients. Psycho-social improvements were less marked. At one year however, cognitive gains (catastrophising, pain distress and depression) were more apparent in the in-patients as they maintained and improved slightly on these measures while out-patient scores deteriorated. In-patients also managed to reduce their drug usage more than out-patients.

Authors' recommendations: The author concludes that the evidence of effectiveness and cost-utility ratio described should be treated with caution. Despite the relative cost-effectiveness of the intervention, the RCT evidence on which this calculation is based is weakened by flawed randomisation processes which limits the generalisability of findings. Research in this area is also weakened by the dependence on largely self-report outcome measures, although there are few alternatives when outcomes of interest include mood, beliefs and pain. The author adds that the modest cost-utility ratio calculated for the evaluation of in-patient pain programmes over out-patient equivalents should be viewed with caution in light of inadequacies in the evidence base.

Authors' methods: Review

Project Status: Completed

URL for project: http://www.wihrd.soton.ac.uk

Year Published: 1997

English language abstract: An English language summary is available

Publication Type: Not Assigned

Country: England

Organisation Name: Wessex Institute for Health Research and Development

Contact Address: Pauline King. Wessex Institute for Health Research and Development, Boldrewood Medical School, Bassett Crescent East, Highfield, Southampton. SO16 7PX Tel. +44 1703 595661 Fax +44 1703 595662

Copyright: Wessex Institute for Health Research and Development (WIHRD)