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Expectations predict chronic pain treatment outcomes

Cormier, Stéphanie; Lavigne, Geneviève L.; Choinière, Manon; Rainville, Pierre

doi: 10.1097/j.pain.0000000000000379
Research Paper
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Accumulating evidence suggests an association between patient pretreatment expectations and numerous health outcomes. However, it remains unclear if and how expectations relate to outcomes after treatments in multidisciplinary pain programs. The present study aims at investigating the predictive association between expectations and clinical outcomes in a large database of chronic pain patients. In this observational cohort study, participants were 2272 patients treated in one of 3 university-affiliated multidisciplinary pain treatment centers. All patients received personalized care, including medical, psychological, and/or physical interventions. Patient expectations regarding pain relief and improvements in quality of life and functioning were measured before the first visit to the pain centers and served as predictor variables. Changes in pain intensity, depressive symptoms, pain interference, and tendency to catastrophize, as well as satisfaction with pain treatment and global impressions of change at 6-month follow-up, were considered as treatment outcomes. Structural equation modeling analyses showed significant positive relationships between expectations and most clinical outcomes, and this association was largely mediated by patients' global impressions of change. Similar patterns of relationships between variables were also observed in various subgroups of patients based on sex, age, pain duration, and pain classification. Such results emphasize the relevance of patient expectations as a determinant of outcomes in multimodal pain treatment programs. Furthermore, the results suggest that superior clinical outcomes are observed in individuals who expect high positive outcomes as a result of treatment.

Pretreatment expectations of patients entering multidisciplinary pain programs predict various clinical outcomes at 6-month follow-up.

aDépartement de psychoéducation et de psychologie, Université du Québec en Outaouais, Gatineau, QC, Canada

bSchool of Nursing, McGill University, Montréal, QC, Canada

cCentre de recherche, Centre hospitalier de l'Université de Montréal, Montréal, QC, Canada

dDépartement d'anesthésiologie, Université de Montréal, Montréal, QC, Canada

eDépartement de stomatologie, Université de Montréal, Montréal, QC, Canada

fCentre de recherche, Institut universitaire de gériatrie de Montréal, Montréal, QC, Canada

gCentre de recherche en neuropsychologie et cognition, Montréal, QC, Canada

hGroupe de recherche sur le système nerveux central, Montréal, QC, Canada

Corresponding author. Address: Département de psychoéducation et de psychologie, Université du Québec en Outaouais, 283, boulevard Alexandre-Taché, bureau C-2803, Case postale 1250, succursale Hull, Gatineau, Québec J8X 3X7, Canada. Tel.: +819 595-3900/1 800 567-1283, poste 2309; fax: +819 595-2250. E-mail address: stephanie.cormier@uqo.ca (S. Cormier).

Sponsorships or competing interests that may be relevant to content are disclosed at the end of this article.

Received June 10, 2015

Received in revised form September 28, 2015

Accepted September 28, 2015

© 2016 International Association for the Study of Pain
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