Predicting treatment outcomes of pain patients attending tertiary multidisciplinary pain treatment centers: A pain trajectory approach

Background: Though multidisciplinary pain treatment (MPT) is considered the gold standard for managing chronic pain, it is unclear which patients benefit most from this high-cost treatment approach. Aims: The goals were to identify subgroups of patients sharing similar pain severity trajectories over time and predictors of MPT responsiveness. Methods: Participants were 1894 patients (mean age = 53.18 years [SD = 14.0]; female = 60.3%) enrolled in the Quebec Pain Registry with moderate to severe baseline pain severity. Patients completed validated questionnaires on pain and related constructs before initiating treatment and 6, 12, and 24 months later. Results: Trajectory analyses of pain severity (intensity and interference) showed that a three-class model best fit the data. Two of the trajectories, which included 24.5% of patients, showed significant improvement in pain severity levels over time (improvers). Compared to patients in the nonimproving trajectory (non-improvers), improvers were younger and more likely to suffer from neuropathic pain and had pain of shorter duration, lower worst pain intensity, lower sleep disturbances and depression scores at baseline, a lower tendency to catastrophize, and better physical health–related quality of life (QOL). This predictive model had a specificity of 96.2% and a sensitivity of 23.6%. Conclusions: Only a minority of patients exhibited an improvement in their pain severity with MPT. Several patients’ characteristics were significantly associated with pain trajectory membership. Early identification of nonimprovers, through examination of baseline characteristics and rates of change in pain scores, can provide valuable information about prognosis and open the doors for evaluation of different cost-effective treatment approaches. Abbreviations: CP = chronic pain; MPT = multidisciplinary pain treatment; QPR = Quebec Pain Registry; QOL = quality of life.