Clustering patients in groups according to their pain acceptance Previous research has suggested that clustering patients according to their pain acceptance can predict treatment outcome. amount of pain the patient is willing to experience while participating in important actitivites. AE : Activity Engagement is the degree to which the patient continues with daily life despite the presence of pain. Linn Wifstrand 1, David Gillanders 2, Graciela Rovner 1,3 Self-report Questionnaires Take home message Behavioral medicine targets ’verbs’. ’To accept pain’ is a verb, a behavior: something we always can do better and improve. Pain symptoms are not behaviors. To assess and group patients according to their pain acceptance helps us understand what they need and to better predict their outcome. Med. Stud. Linn Wifstrand 1 Institute of Neuroscience and Physiology at Sahlgrenska Academy, University of Gothenburg Rehabilitation Medicine, SWEDEN 3 Rehabilitation Medicine, Dept of Clinical Sciences Karolinska Institutet, Danderyd University Hospital Stockholm, SWEDEN 2 Psychology School, University of Edinburgh Scotland, UK ACT focuses on function rather than on controlling thoughts, emotions or symptoms. The goal of rehabilitation is to help patients live a meaningful life despite their pain. Focusing on their values, the program improved their willingness to experience pain (or negative thoughts or emotions) while choosing to live a vital life. Multi-Professional Rehabilitation for Chronic Pain There is strong evidence for the effectiveness of behavioral-based rehabilitation programs for patients with chronic pain, both those based on Acceptance & Commitment Therapy (ACT) and those on Cognitive Behavioral Therapy (CBT) Multi-Professional Rehabilitation for Chronic Pain There is strong evidence for the effectiveness of behavioral-based rehabilitation programs for patients with chronic pain, both those based on Acceptance & Commitment Therapy (ACT) and those on Cognitive Behavioral Therapy (CBT) CBT encourages patients to develop coping strategies to avoid external stressors and teaches patients ’adaptive’ skills through exposure, education, relaxation and cognitive restructuring. The idea is that the patients need to control thoughts and emotions to modify ’maladaptive’ pain behaviors. What is not known is which group of patients benefit best of these rehabilitation programs Aim: to investigate the patients’ differential response to various rehabilitation packages Main findings Research questions ACT group: widespread pain, 89.3% women, low in quality of life and all functional levels and high in pain levels CBT group: neck and/or back pain, 60.5% women and better in all aspects 1 ACT & CBT groups: Differences at base-line? Both groups improved in quality of life, pain, mental and physical function. The ACT group improved in more areas and greately in physical function 2 ACT & CBT groups: Differential responses? Distinct differences were found among clusters in all aspects The greatest difference was between the ’high’ and the ’low’ cluster, where the ’low’ reported feeling worse in all aspects 3 Clusters: Differences at base-line? Clusters that underwent ACT rehabilitation improved in more areas than those that underwent CBT 4 Clusters: Differential responses? Both the ’high’ and ’low’ clusters improved more after ACT rehabilitation regarding their physical function This difference was the largest for the ’low’ cluster 5 Is ACT or CBT more effective? Conclusions The ACT group benefited across more domains than the CBT group Distinct differences were found regarding improvement of physical function between ACT and CBT groups Acceptance-based clusters are effective as indicators for: Quality of life and functional differences among patients at base-line Differential responses to rehabilitation The patients were grouped in four clusters by performing hierarchical cluster analysis on their pain acceptance scores from the CPAQ two subscales: PW: Pain Willingness is the Dr. David Gillanders Dr. Graciela Rovner Middle High in QoL Physical Function Mental Function Social Function Pain Middle High in QoL Physical Function Mental Function Social Function Pain Higher in QoL Mental Function Physical Function Social Function Lower in Pain Higher in QoL Mental Function Physical Function Social Function Lower in Pain Lower in QoL Mental Function Physical Function Social Function Higher in Pain Lower in QoL Mental Function Physical Function Social Function Higher in Pain Middle low in QoL Mental Function Physical Function Social Function Pain Middle low in QoL Mental Function Physical Function Social Function Pain High AE Low PW High AE High PW Low AE High PW Low AE Low PW PAIN WILLIGNESS (PW) ACTIVITY ENGAGEMENT (AE ) 4 CLUSTERS T-test/X 2 group differences ANOVA total cluster differences T-test outcome Mixed between-within subjects ANOVA outcome differences depending on rehabilitation type In between ACT and CBT and in between all clusters T-test outcome differences Study Design & Statistics 2 5 ScalesSubscales QoLPain Physical Funct. Mental Funct. Social Funct. HAD Anxiety X Depression X SF-36 Medical Outcome Study Short Form 36 Physical Function X Role Physical X Bodily Pain X General HealthX VitalityX Social Function X Role Emotional X Mental HealthX X Physical Comp. Sum. X Mental Comp. Sum. X CPAQ Activity Engagement X Pain Willingness X MPI Pain Severity X EQ-5D IndexX TSK Kinesiophobia X QoL: Qualtiy of Life HAD: Hospital Anxiety and Depression Scale CPAQ-8: Chronic Pain Acceptance Questionnaire, 8 items MPI: Multidimensional Pain Inventory EQ-5D: European Quality of Life- 5 Dimentions TSK: Tampa Scale for Kinesiophobia