Criteria for Treatment Success

The evaluation of treatment success must include several considerations listed below:

1. Pain reduction: The most common criterion measure of outcome in various treatment approaches for pain problem. Dvorak and colleagues studied 575 patients who were operated on lumbar disk herniation and concluded that 70% continued to complain of back pain 4-17 years after surgery (Dvorak et al. 1988). Pain reduction following treatment at MPCs ranged from 20 to 40% (Flor et al. 1992). Studies investigating the long-term maintenance of pain reduction observed at discharge tend to be maintained at follow up of up to 2 years. In a direct comparison, Gallon showed that only 17% of the surgical patients viewed themselves as improved as compared to 38% of non-surgical-treated patients.

2. Iatrogenic complications: Surgical procedures themselves sometimes may cause additional problem that may require repeat surgery. In a series of 78 surgical patients, Long et al.

observed that 11.6% developed serious complications from the procedure. In contrast to surgery, MPCs rarely report any significant iatrogenic problems following treatment.

3. Elimination or reduction of opioid medication: Flor et al. found that over 50% of patients treated at MPCs were taking opioid medication on admission (Flor et al. 1992). Because of potentially detrimental effects of opioids and attempts to encourage self-initiated pain treatment elimination or reduction of opioids intake is an important part of most multidisciplinary treatment programs.

In general, MPCs appear to be effective in eliminating or greatly reducing opioid intake in chronic pain patients. Studies report that up to 100% of patients decrease opioid use by the time of treatment terminations at MPCs. Over 65% of treated patients remain opioid-free at 1-year follow up.

4. Utilization of health care system: MPCs effectively reduce utilization of the health care system following treatment. About 60-90% of patients did not seek any additional treatment for their pain during a 3-12-month post-treatment period. Compared to conventionally treated patients (i.e., medication and/or surgery), MPCs consistently show superior rate of reduced health care utilization (Fig. 2.1).

5. Increase in activity: According to quantitative review of outcome studies (Flor et al. 1992), substantially greater increase in activity level occurred in patients treated at MPCs (65%) compared to conventionally treated patients (35%).

6. Return to work: Although return to work is an important outcome as it has significant socioeconomic implications, several factors impede patient's return to work aside from their pain. Return to gainful employment for chronic pain patients depends on factors such as local economy, job availability, and the aggressiveness of care managers. The average time off from work is 7 years. Skills that were useful prior to the pain onset may be outdated making patients less marketable. The results of 11 studies with 259

i MPC Treated ■ Conventionally Treated

70 60 50 40 30 20 10

i MPC Treated ■ Conventionally Treated

63/133

51/182

27/262

19/145

Surgery

Hospitalization

Surgery

Peace in Pain

Peace in Pain

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