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Effect of an interdisciplinary outpatient pain management program for chronic pain patients with and without migration background

Scascighini et al.
Reply to the review of the article: Effect of an interdisciplinary outpatient pain management program for chronic pain patients with and without migration background: A prospective, observational clinical study.
Pain Medicine, Wiley periodicals Inc. 20/11

First of all, we wish to thank Prof. Dr. med. Beat Michel for his interest in our study examining the influence of a migration background after a bio-psychosocial, multidisciplinary pain program (IOPP). Daily we are confronted with people from various geo-cultural regions suffering from debilitating, persistent pain. What concretely can we do for them? Scientific literature recommends assessing and treating these patients in a multidisciplinary setting, such as in the program described in the cited paper (Interdisciplinary Outpatient Pain Program-IOPP). The primary aim of the IOPP is to teach and educate the patients how to cope with chronic health conditions widely recognized as a major public health topic.

In the mentioned study, we used the term ‘chronic pain’ as defined by the IASP: “pain of any etiology not directly related to neoplastic involvement, associated with a chronic medical condition or extending in duration beyond the expected temporal boundary of tissue injury and normal healing, and adversely affecting the function or well-being of the individual”. Our aim is therefore not primarily to change the intensity of the pain, which is a multi-factorial sensation, but to improve the personal abilities and skills to cope with this unpleasant, life-limiting pathology in order to improve the patients’ quality of life.

In our opinion, the results shown in this program, in particular during the post-treatment period, reflect a great achievement. The patients were frequently referred into this program as a final resort after a plethora of failed monodisciplinary approaches. As yet there is no better evidence-based therapeutic alternative to improve the psychological and physical functioning of these patients. Unfortunately, as shown in similar studies, it is not possible to speak about healing in this specific population

Prof. Dr. Beat Michel raises a further interesting point about the discrepancy between the allocation of resources and the results of the program. Most international pain management programs are in-patient programs running on a full time basis for three to four weeks. In contrast the IOPP patients attend two half days per week during eight weeks. Taking this fact into account, the program has to be classified as a low key intervention program with regards to the allocated resources (human and finances); the results should thus only be compared to similar programs. Chronic pain brings about neuroplastic changes on a spinal, supraspinal, and cortical level. To reverse these structural changes an optimal environment (work, family, social and medical support), time and patience are needed. The latest analysis of the program’s data collected since 2005 shows promising and enhanced outcomes (submitted for publication in a peer-reviewed journal). High levels of anxiety, depression, passive coping at the start of the program as well as a migration background seem to correlate with reduced improvement over time. However, statistically significant improvements in outcome are observed in patients with lower levels of anxiety, depression and in those with no migration background. We firmly believe that the results of this clinical study are truly helpful to improve and modify specific aspects of this more than 10-year old program.

Sincerely,

Luca Scascighini, MPtSc, BSc PT

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