Ulysses: the effectiveness of a multidisciplinary cognitive behavioural pain management programme—an 8-year review

Abstract

Objectives

To characterise a cohort of patients with chronic pain registered to the Ulysses cognitive behavioural pain management programme (CBT-PMP) and to evaluate the effectiveness of the CBT-PMP 6 months post-discharge.

Methods

A review of patients referred to the Ulysses CBT-PMP from 2002 to 2010 was undertaken. The profile of patients was established. Domains measured included pain, physical and psychological function. Relationships between these factors were explored. Clinically significant changes in outcome measures were established at the 6-month follow-up.

Results

In total 553 patients registered to the CBT-PMP, pre–post data were available for 91 % of patients and 52 % at 6 months. The majority of patients were female and aged between 40 and 50 years. Most patients had significant psychological morbidity (76 % depression, 84.5 % anxiety), moderate reports of pain [numerical rating scale, mean (SD) 6.0 (2.2)], and low levels of functional activity. At 6 months follow-up, statistically significant positive findings for physical and psychological outcome measures are supplemented by results showing their clinical significance. With regard to psychological function, a clinically significant change (depending on outcome measure) was shown between 1 in 2 and 1 in 10 patients. Improvements in physical function were lower with rates of 1 in 4 to 1 in 14 reporting significant gains.

Conclusion

The effectiveness of the Ulysses CBT-PMP is established with measures of clinically significant change for physical and psychological outcomes contributing to the evidence for this novel approach of analysis. Future research determining benchmarks for CBT-PMP outcomes will assist clinicians in monitoring and enhancing patient’s progress in clinical practice.

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References

  1. 1.

    Breivik H, Collett B, Ventafridda V et al (2006) Survey of chronic pain in Europe: prevalence, impact on daily life, and treatment. Eur J Pain 2006(4):287–333

    Article  Google Scholar 

  2. 2.

    Bonica JJ, Loeser JD (2000) History of pain concepts and therapies. Bonica’s management of pain. 3rd edition. Lippincott Williams & Wilkins, Philadelphia

  3. 3.

    Raftery MN, Sarma K, Murphy AW et al (2011) Chronic pain in the Republic of Ireland– community prevalence, psychosocial profile and predictors of pain-related disability: results from the prevalence, impact and cost of chronic pain (PRIME) study, part 1. Pain 5:1096–1103

    Article  Google Scholar 

  4. 4.

    Fullen B, Hurley DA, Power C et al (2006) The need for a national strategy for chronic pain management in Ireland. Ir J Med Sci 2:68–73

    Article  Google Scholar 

  5. 5.

    Turk DC (2002) Clinical effectiveness and cost-effectiveness of treatments for patients with chronic pain. Clin J Pain 6:355–365

    Article  Google Scholar 

  6. 6.

    Airaksinen O, Brox JI, Cedraschi C et al (2006) European guidelines for the management of chronic non-specific low back pain. Eur Spine J 15(Suppl 2):S192–S300

    PubMed Central  PubMed  Article  Google Scholar 

  7. 7.

    Keefe FJ (2000) Pain behavior observation: current status and future directions. Curr Rev Pain 1:12–17

    Article  Google Scholar 

  8. 8.

    British Pain Society. www.britishpainsociety.org. Accessed 8 March 2013

  9. 9.

    McCracken LM, Turk DC (2003) Behavioral and cognitive-behavioral treatment for chronic pain: outcome, predictors of outcome, and treatment process. Spine 27:2564–2573

    Article  Google Scholar 

  10. 10.

    Morley S, Williams A, Hussain S (2008) Estimating the clinical effectiveness of cognitive behavioural therapy in the clinic: evaluation of a CBT informed pain management programme. Pain 137(3):670–680

    PubMed  Article  Google Scholar 

  11. 11.

    Eccleston C, Williams AC, Morley S (2009) Psycholoical therapies for the management of chronic pain (excluding headache) in adults. Cochrane Database Syst Rev 15(2):CD007407

    Google Scholar 

  12. 12.

    Williams AC, Eccleston C, Morley S (2012) Psychological therapies for the management of chronic pain (excluding headache) in adults. Cochrane Database Syst Rev 11:CD007407

    PubMed  Google Scholar 

  13. 13.

    Kendal PC, Marrs-Garcia A, Nath SR et al (1999) Normative comparison for the evaluation of clinical significance. J Consult Clin Psychol 67:285–299

    Article  Google Scholar 

  14. 14.

    McCracken LM, MacKichan F, Eccleston C (2007) Contextual cognitive-behavioral therapy for severely disabled chronic pain sufferers: effectiveness and clinically significant change. Eur J Pain 11(3):314–322

    PubMed  Article  Google Scholar 

  15. 15.

    Morley S, Williams A (2002) Conducting and evaluating treatment outcome studies. In: Turk DC, Gatchel RJ (eds) Psychological approaches to pain management, 2nd edn. The Guilford Press, New York, pp 52–70

    Google Scholar 

  16. 16.

    Jacobson NS, Truax P (1991) Clinical significance: a statistical approach to defining meaningful change in psychotherapy research. J Consult Clin Psychol 59(1):12–19

    PubMed  Article  CAS  Google Scholar 

  17. 17.

    Jaeschke R, Singer J, Guyatt GH (1989) Ascertaining the minimal clinically important difference. Cont Clin Trials 10:407–415

    Article  CAS  Google Scholar 

  18. 18.

    Copay AG, Subach BR, Glassman SD et al (2007) Understanding the minimum clinically important difference: a review of concepts and methods. Spine J 7(5):541–546

    PubMed  Article  Google Scholar 

  19. 19.

    Crosby RD, Kolotkin RL, Williams GR (2003) Defining clinically meaningful change in health-related quality of life. J Clin Epidemiol 56(5):395–407

    PubMed  Article  Google Scholar 

  20. 20.

    Nicholas MK, Asghari A, Corbett M et al (2012) Is adherence to pain self-management strategies associated with improved pain, depression and disability in those with disabling chronic pain? Eur J Pain 1:93–104

    Article  Google Scholar 

  21. 21.

    Van Weering MG, Vollenbroek-Hutten MM, Tonis TM et al (2009) Daily physical activities in chronic lower back pain patients assessed with accelerometry. Eur J Pain 13(6):649–654

    PubMed  Article  Google Scholar 

  22. 22.

    Huijnen IP, Verbunt JA, Peters ML et al (2010) Do depression and pain intensity interfere with physical activity in daily life in patients with chronic low back pain? Pain 150(1):161–166

    PubMed  Article  Google Scholar 

  23. 23.

    Dysvik E, Vinsnes AG, Eikeland OJ (2004) The effectiveness of a multidisciplinary pain management programme managing chronic pain. Int J Nurs Pract 5:224–234

    Article  Google Scholar 

  24. 24.

    Bosy D, Etlin D, Corey D (2010) An interdisciplinary pain rehabilitation programme: description and evaluation of outcomes. Physiother Can 4:316–326

    Article  Google Scholar 

  25. 25.

    Beissner K, Parker SJ, Henderson CR Jr (2012) A cognitive-behavioral plus exercise intervention for older adults with chronic back pain: race/ethnicity effect? J Aging Phys Act 2:246–265

    Google Scholar 

  26. 26.

    Calvert M, Duffy H, Freemantle N et al (2012) Population health status of South Asian and African-Caribbean communities in the United Kingdom. BMC Health Serv Res 12:101

    PubMed Central  PubMed  Article  Google Scholar 

  27. 27.

    Fullen BM, Doody C, Baxter GD et al (2008) Chronic low back pain: non-clinical factors impacting on management by Irish doctors. Ir J Med Sci 3:257–263

    Article  Google Scholar 

  28. 28.

    Fordyce WE (1976) Behavioural methods for chronic pain and illness. Mosby, St Louis

    Google Scholar 

  29. 29.

    Turk DC, Meichenbaum D, Genest M (1983) Pain and Behavioural medicine: a cognitive behavioural perspective. Guilford Press, New York

    Google Scholar 

  30. 30.

    Downie WW, Leatham PA, Rhind VM et al (1978) Studies with pain rating scales. Ann Rheum Dis 4:378–381

    Article  Google Scholar 

  31. 31.

    Jensen MP, Mcfarland C (1993) A increasing the reliability and validity of pain intensity measurement in chronic pain patients. Pain 2:195–203

    Article  Google Scholar 

  32. 32.

    Bolton JE, Wilkinson RC (1998) Responsiveness of pain scales: a comparison of three pain intensity measures in chiropractic patients. J Manipulative Physiol Ther 1:1–7

    Google Scholar 

  33. 33.

    Zigmond AS, Snaith RP (1983) The hospital anxiety and depression scale. Acta Psychiatr Scand 6:361–370

    Article  Google Scholar 

  34. 34.

    Rosenstiel A, Keefe FJ (1983) The use of coping strategies in chronic low back pain patients:relationship to patient characteristics ad current adjustment. Pain 17:33–44

    PubMed  Article  CAS  Google Scholar 

  35. 35.

    Skevington SM (1990) A standardised scale to measure beliefs about controlling pain (BPCQ): a preliminary study. Psychol Health 4:221–232

    Article  Google Scholar 

  36. 36.

    Levenson H, Miller J (1976) Multi-dimesnional locus of control in socio-political activists of conservative and liberal ideologies. J Pers Soc Psychol 33:199–208

    PubMed  Article  CAS  Google Scholar 

  37. 37.

    Wallston KA, Kaplan GD, Maides SA (1976) Development and validation of the Health locus of control (HLC) scale. J Consult Clin Psychol 44:580–585

    PubMed  Article  CAS  Google Scholar 

  38. 38.

    Roland M, Morris R (1983) A study of the natural history of back pain. Part I: development of a reliable and sensitive measure of disability in low-back pain. Spine 8(2):141–144

    PubMed  Article  CAS  Google Scholar 

  39. 39.

    Swinkels-Meewisse EJ, Swinkels RA, Verbeek AL (2003) Psychometric properties of the Tampa Scale for kinesiophobia and the fear-avoidance beliefs questionnaire in acute low back pain. Man Ther 8(1):29–36

    PubMed  Article  CAS  Google Scholar 

  40. 40.

    Vlaeyen JW, Kole-Snijders AM, Boeren RG (1995) Fear of movement/(re)injury in chronic low back pain and its relation to behavioral performance. Pain 62(3):363–372

    PubMed  Article  CAS  Google Scholar 

  41. 41.

    Waddell G, Newton M, Henderson I et al (1993) A Fear-Avoidance Beliefs Questionnaire (FABQ) and the role of fear-avoidance beliefs in chronic low back pain and disability. Pain 2:157–168

    Article  Google Scholar 

  42. 42.

    Simmonds MJ, Olson SL, Jones S et al (1998) Psychometric characteristics and clinical usefulness of physical performance tests in patients with low back pain. Spine 22:2412–2421

    Article  Google Scholar 

  43. 43.

    Novy DM, Simmonds MJ, Olson SL et al (1999) Physical performance: differences in men and women with and without low back pain. Arch Phys Med Rehabil 2:195–198

    Article  Google Scholar 

  44. 44.

    Patrick D, Peach H (eds) (1989) Disablement in the Community: a sociomedical press perspective. Oxford University Press, Oxford

    Google Scholar 

  45. 45.

    McDowell I, Newell C (2006) Measuring Health: a guide to rating scales and questionnaires. Oxford University Press, New York

  46. 46.

    Cohen JW (1998) Statistical power analysis for the behavioural sciences. Lawrence Erlbaum Associates, Hillsdale

    Google Scholar 

  47. 47.

    Jacobson NS, Roberts LJ, Berns SB (1999) Methods for defining and determining the clinical significance of treatment effects: description, application, and alternatives. J Consult Clin Psychol 67:300–307

    PubMed  Article  CAS  Google Scholar 

  48. 48.

    Cepeda MS, Africano JM, Polo R et al (2003) Agreement between percentage pain reductions calculated from numeric rating scores of pain intensity and those reported by patients with acute or cancer pain. Pain 106:439–442

    PubMed  Article  Google Scholar 

  49. 49.

    Cepeda MS, Africano JM, Polo R et al (2003) What decline in pain intensity is meaningful to patients with acute pain? Pain 105:151–157

    PubMed  Article  Google Scholar 

  50. 50.

    Farrar JT, Young JP Jr, LaMoreaux L et al (2001) Clinical importance of changes in chronic pain intensity measured on an 11-point numerical pain rating scale. Pain 94:149–158

    PubMed  Article  CAS  Google Scholar 

  51. 51.

    McCracken LM, MacKichan F, Eccleston C (2007) Contextual cognitive-behavioral therapy for severely disabled chronic pain sufferers: effectiveness and clinically significant change. Eur J Pain 11(3):314–322

    PubMed  Article  Google Scholar 

  52. 52.

    Weston D, Novotny CM, Thompson-Brenner H (2004) The empirical status of empirically supported psychotherapies: assumptions, findings, and reporting in controlled clinical trials. Psychol Bull 130:631–663

    Article  Google Scholar 

  53. 53.

    Scascighini L, Toma V, Dober-Spielmann S et al (2008) Multidisciplinary treatment for chronic pain: a systematic review of interventions and outcomes. Rheumatology 47(5):670–678

    PubMed  Article  CAS  Google Scholar 

  54. 54.

    Wand BM, O’Connell NE (2008) Chronic non-specific low back pain—subgroups or a single mechanism? BMS Musculoskeletal Disord 9(11):1–15

    Google Scholar 

  55. 55.

    Thorne FM, Morley S (2009) Prospective judgments of acceptable outcomes for pain, interference and activity: patient-determined outcome criteria. Pain 144(3):262–269

    PubMed  Article  Google Scholar 

  56. 56.

    Morley S, Williams AC (2006) RCTs of psychological treatments for chronic pain: progress and challenges. Pain 121:371–372

    Article  Google Scholar 

  57. 57.

    Lin CW, McAuley JH, Macedo L et al (2011) Relationship between physical activity and disability in low back pain: a systematic review and meta-analysis. Pain 152(3):607–613

    PubMed  Article  Google Scholar 

  58. 58.

    Guclu DG, Guclu O, Ozaner A et al (2012) The relationship between disability, quality of life and fear-avoidance beliefs in patients with chronic low back pain. Turk Neurosurg 22(6):724–731

    PubMed  Google Scholar 

  59. 59.

    Simmonds MJ (2002) Physical function in patients with cancer: psychometric characteristics and clinical usefulness of a physical performance test battery. J Pain Symptom Manage 24(4):404–414

    PubMed  Article  Google Scholar 

  60. 60.

    (2010) ACSM’s guidelines for Exercise Testing and Prescription. Lippincott Williams & Wilkins, Philadelphia

  61. 61.

    Lee JQ, Simmonds MJ, Wang XS, Novy DM (2003) Differences in physical performance between men and women with and without lymphoma. Arch Phys Med Rehabil 84(12):1747–1752

    PubMed  Article  Google Scholar 

  62. 62.

    Simmonds MJ, Novy D, Sandoval R (2005) The differential influence of pain and fatigue on physical performance and health status in ambulatory patients with human immunodeficiency virus. Clin J Pain 21(3):200–206

    PubMed  Article  Google Scholar 

  63. 63.

    Guzmán J, Esmail R, Karjalainen K et al (2001) Multidisciplinary rehabilitation for chronic low back pain: systematic review. BMJ 322:1511–1516

    PubMed Central  PubMed  Article  Google Scholar 

  64. 64.

    Verbunt JA, Westerterp KR, Van Der Heijden GJ et al (2001) Physical activity in daily life in patients with chronic low back pain. Arch Phys Med Rehabil 82(6):726–730

    PubMed  Article  CAS  Google Scholar 

  65. 65.

    Spenkelink CD, Hutten MM, Hermens HJ et al (2002) Assessment of activities of daily living with an ambulatory monitoring system: a comparative study in patients with chronic low pain and nonsymptomatic controls. Clin Rehabil 16(1):16–26

    PubMed  Article  CAS  Google Scholar 

  66. 66.

    Ryan CG, Gray HG, Newton M (2010) The relationship between psychological distress and freeliving physical activity in individuals with chronic low back pain. Man Ther 15(2):185–189

    PubMed  Article  Google Scholar 

  67. 67.

    Roth AD, Fonagy P (2005) What works for whom: a critical review of psychotherapy research, 2nd edn. Guildford Press, New York

    Google Scholar 

  68. 68.

    Darlow B, Fullen BM, Dean S et al (2012) The association between health care professional attitudes and beliefs and the attitudes and beliefs, clinical management, and outcomes of patients with low back pain: a systematic review. Eur J Pain 16(1):3–17

    PubMed  Article  CAS  Google Scholar 

  69. 69.

    Vowles KE, McCracken LM (2008) Acceptance and values based action in chronic pain: a study of treatment effectiveness and progress. J Consult Clin Psychol 76:397–407

    PubMed  Article  Google Scholar 

  70. 70.

    Fullen BM, Baxter GD, Doody C et al (2011) General practitioners’ attitudes and beliefs regarding the management of chronic low back pain in Ireland: a cross-sectional national survey. Clin J Pain 27(6):542–549

    PubMed  Article  Google Scholar 

  71. 71.

    Kolt GS, McEvoy JF (2003) Adherence to rehabilitation in patients with low back pain. Man Ther 8(2):110–116

    PubMed  Article  CAS  Google Scholar 

  72. 72.

    Middleton A (2004) Chronic low back pain: patient compliance with physiotherapy advice and exercise, perceived barriers and motivation. Phys Ther Rev 9:153–160

    Article  Google Scholar 

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Acknowledgments

Ms Catherine Paisley, Pain Service, Adelaide and Meath Hospital, Tallaght, Dublin 24.

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Correspondence to B. M. Fullen.

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Fullen, B.M., Blake, C., Horan, S. et al. Ulysses: the effectiveness of a multidisciplinary cognitive behavioural pain management programme—an 8-year review. Ir J Med Sci 183, 265–275 (2014). https://doi.org/10.1007/s11845-013-1002-2

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Keywords

  • Cognitive behavioural pain management programme
  • Clinical significant changes
  • Chronic pain