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Evaluation of Group and Individual Change in a Multidisciplinary Pain Management Program

Fedoroff, Ingrid C. PhD; Blackwell, Ekin PhD; Speed, Brittany BA

The Clinical Journal of Pain: May 2014 - Volume 30 - Issue 5 - p 399–408
doi: 10.1097/AJP.0b013e31829ea1f7
Original Articles

Objectives: Systematic reviews have consistently shown that multidisciplinary interventions are more effective than waitlist and other unimodal active treatments for a range of chronic pain conditions. However, these group-based statistics fail to inform us whether these programs result in clinically meaningful improvement at the individual level. The current study examines group changes and individual responsiveness to a CBT-informed multidisciplinary chronic pain management program.

Methods: The analyses are based on data obtained from 263 outpatients. In addition to examining group-based treatment effects, we evaluated individual responsiveness to the program using 3 different criteria for assessing clinically important change.

Results: Statistically significant improvement was found for all measures at posttreatment, with effect sizes ranging from small to medium. Gains were largely maintained at follow-up. The results of the clinically important change analysis revealed that not everyone improved uniformly, and the magnitude of change varied across the 3 different methods. This variability in the extent of improvement prompted further analyses in an attempt to identify individual differences that could predict responsiveness to treatment. No differences were found between responders and nonresponders to treatment.

Discussion: The results of our study are consistent with previous research, and highlight the potential for multidisciplinary programs to improve the well-being of individuals with chronic pain. Clinically important change analyses underscore the variability that exists in chronic pain patients and allows for a more fine grained evaluation of individual responsiveness to treatment. Considering the strengths and limitations of each methodological approach for assessing clinically important change, guidelines are offered for future research and program development.

Chronic Pain Centre, St Paul’s Hospital, Vancouver, BC, Canada

Supported by a MITACS grant, which includes 3 sources of funding: government (provincial and federal), industry (Medtronic of Canada Ltd., Brampton, Ontario), and the St Paul’s Hospital Chronic Pain Centre, Vancouver, BC, Canada. The authors declare no conflict of interest.

Reprints: Ingrid C. Fedoroff, PhD, Chronic Pain Centre, St Paul’s Hospital, 4th Floor Burrard Building, 1081 Burrard Street, Vancouver, BC, Canada V6Z 1Y6 (e-mail:

Received August 13, 2012

Accepted May 21, 2013

© 2014 by Lippincott Williams & Wilkins