Multidimensional success criteria and expectations for treatment of chronic pain: the patient perspective.
OBJECTIVE: The study's primary objective is to define treatment success from the patient perspective across four domains (pain, fatigue, emotional distress, interference with daily activities) using the Patient Centered Outcomes Questionnaire (PCOQ). Secondary objectives include examination of patient expectations for treatment across domains and derivation of patient subgroups based on PCOQ responses. DESIGN: Cross-sectional. Setting. University of Florida or affiliated pain clinics. Patients. Participants were 110 patients seeking treatment for chronic pain who completed the PCOQ before their routine medical appointment. RESULTS: Patients reported moderate usual levels of pain (mean = 6.1), fatigue (mean = 5.9), distress (mean = 5.5), and interference (mean = 6.4). Patients considered a mean reduction in pain of 3.4 points (56%) to represent treatment success. Mean reductions in fatigue, distress, and interference of 3.35 points (57%), 3.64 points (65%), and 4.3 points (68%), respectively, also signified treatment success. Analyses revealed patients expected their level of interference following treatment (mean = 2.6) to be higher than their success criterion for interference (mean = 2.0). Cluster analysis of PCOQ responses revealed a three-cluster solution. Differences were obtained among clusters on demographic and pain-related variables. CONCLUSIONS: Patients might require larger reductions in pain than has previously been reported in the literature as "meaningful" for them to consider treatment successful. Patients did not expect treatment to meet their criterion for success in the interference domain, suggesting patients' success criteria and treatment expectations might differ for some domains. The finding of patient subgroups has implications for treatment matching.
Robinson, ME; Brown, JL; George, SZ; Edwards, PS; Atchison, JW; Hirsh, AT; Waxenberg, LB; Wittmer, V; Fillingim, RB
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