Pain Rehabilitation: Patient Centered Outcomes

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DESCRIPTION (provided by applicant): The extremely high personal and financial costs of chronic pain make it one of the most pressing health issues. Despite empirical support for the efficacy of some treatments, the prevalence of chronic pain conditions continues to rise. We propose that one reason that patients continue to seek treatment, despite availability of empirically validated treatments is that the outcome measures and success criteria typically employed in pain treatment studies are not patient defined, and do not assess clinical relevance. The purpose of this project is to compare pain treatment outcome from the perspective of the patient with traditional measures of treatment outcome. Obtaining patient centered and defined treatment success assessments across multiple domains (pain intensity, negative affect, function) will allow for a more clinically relevant determination of treatment success. We will make direct comparisons of traditional outcome measures and nomothetic statistical comparisons of those measures with patient centered, clinically relevant outcomes. We will employ a number of innovative measurement approaches to address the outcome and success of two types of treatment for chronic pain: cognitive-behavioral rehabilitation, and oral opioid treatment. We will assess specific hypotheses about how these treatments influence change in success criteria across multiple treatment domains. In a longitudinal design, treatment outcome/success will be assessed via patient centered self report of: pain intensity, negative affect, and function. Physical function will also be assessed with physical performance measures. Results of the project will provide more clinically relevant assessment of pain treatment success, better definition of common effect sizes for these treatments (ie. NNT) and will provide preliminary data on the tailoring of treatments. These data will also improve our understanding of the mechanisms underlying Cognitive-Behavioral Treatments and Oral Opioid Treatment of chronic pain conditions.