Dermatology & Plastic Surgery Institute Outcomes
Pain
Outcomes in Chronic Pain Neuro-Rehabilitation Program
Cleveland Clinic's Chronic Pain Neuro-Rehabilitation Program (CPNP) is an intensive pain program (IPP) that focuses primarily on physical reconditioning, medication management, social reengagement, and psychological coping strategies to ensure that chronic pain and other complex neurological symptoms do not take over a person's life. The goal of this program is to restore maximum level of comfort and function among those with persistent pain conditions. This program is offered in a predominantly virtual format wherein patients participate in group behavioral sessions 4 hours per day, 4 days per week, as well as virtual medication management appointments. This program also includes participation in a physical and occupational therapy program, which is delivered in person.
Among patients who completed the IPP, there were statistically and clinically meaningful improvements in depression, pain catastrophizing, PROMIS fatigue, pain interference, and self-efficacy for managing symptoms. Non-completers improvements are likely attributed to other treatment effects not controlled for in this analysis, such as receiving other treatments within or outside of the center. When comparing magnitude of improvements between IPP completers and non-completers, IPP completers improved to a greater degree across areas of pain coping and self-efficacy. While these differences were not statistically significant (possibly due to small sample sizes), they are clinically meaningful.
Demographics of Patients Recommended for CPNP
| All Patients | Completed IOP | Did Not Attend or Dropped Out of IOP | P Value* | |
|---|---|---|---|---|
| N | 316 | 98 | 218 | |
| Age, mean (SD) | 48.0 (13.9) | 48.1 (13.5) | 47.9 (14.1) | 0.918 |
| Female | 243 (76.9%) | 76 (77.6%) | 167 (76.6%) | 0.886 |
| Race | 0.024 | |||
| White | 246 (77.8%) | 67 (68.4%) | 179 (82.1%) | |
| Black | 41 (13.0%) | 18 (18.4%) | 23 (10.6%) | |
| Other | 29 (9.2%) | 13 (13.3%) | 16 (7.9%) | |
| Marital Status | 0.9 | |||
| Married | 153 (48.4%) | 45 (45.9%) | 108 (49.5%) | |
| Single | 110 (34.8%) | 37 (37.8%) | 73 (33.5%) | |
| Divorced | 45 (14.2%) | 13 (13.3%) | 32 (14.7%) | |
| Widowed | 5 (1.6%) | 2 (2.0%) | 3 (1.4%) | |
| Missing | 3 (0.9%) | 1 (1.0%) | 2 (0.9%) | |
| Median Income by ZIP Code (x $1000), mean (SD) | 52.8 (19.5) | 54.2 (17.3) | 52.2 (20.4) | 0.382 |
CPNP = Chronic Pain Neuro-Rehabilitation Program, IOP = intensive outpatient program.
Outcomes in CPNP Graduates
| All Patients | IOP Completers | IOP Non-Completers | Between Group P-value* | ||
|---|---|---|---|---|---|
| PHQ - 9 Score | N | 73 | 55 | 18 | |
| Pre-IOP | 13.7 (6.7) | 14.7 (6.4) | 10.8 (6.8) | ||
| Post-IOP | 10.9 (6.6) | 11.6 (6.3) | 8.7 (7.1) | ||
| Change | -2.8 (5.4) | -3.1 (4.7) | -2.1 (7.4) | 0.576 | |
| Within P-value | <0.001 | <0.001 | 0.254 | ||
| GAD-7 Score | N | 42 | 33 | 9 | |
| Pre-IOP | 13.6 (5.7) | 14.9 (4.1) | 9.1 (8.3) | ||
| Post-IOP | 11.6 (5.8) | 12.5 (5.0) | 8.3 (7.4) | ||
| Change | -2.0 (4.7) | -2.4 (4.3) | -0.8 (6.1) | 0.475 | |
| Within P-value | 0.008 | 0.003 | 0.714 | ||
| PCS Helplessness | N | 60 | 48 | 12 | |
| Pre-IOP | 13.4 (6.0) | 14.0 (5.9) | 11.1 (6.3) | ||
| Post-IOP | 9.3 (6.8) | 9.5 (6.8) | 8.7 (7.3) | ||
| Change | -4.1 (4.8) | -4.5 (4.8) | -2.4 (4.9) | 0.207 | |
| Within P-value | <0.001 | <0.001 | 0.115 | ||
| PCS Magnification | N | 60 | 49 | 11 | |
| Pre-IOP | 5.4 (3.4) | 5.8 (3.1) | 3.6 (4.0) | ||
| Post-IOP | 3.8 (3.4) | 4.2 (3.5) | 1.8 (1.8) | ||
| Change | -1.6 (2.8) | -1.5 (2.8) | -1.8 (2.9) | 0.766 | |
| Within P-value | <0.001 | <0.001 | 0.061 | ||
| PCS Rumination | N | 60 | 48 | 12 | |
| Pre-IOP | 9.6 (4.5) | 10.4 (4.2) | 6.3 (4.5) | ||
| Post-IOP | 6.9 (4.8) | 7.2 (4.7) | 5.4 (4.9) | ||
| Change | -2.7 (3.8) | -3.2 (3.4) | -0.9 (4.9) | 0.155 | |
| Within P-value | <0.001 | <0.001 | 0.529 | ||
| PCS Total | N | 58 | 47 | 11 | |
| Pre-IOP | 28.4 (13.2) | 30.1 (12.3) | 21.5 (15.3) | ||
| Post-IOP | 20.1 (14.2) | 21.5 (14.3) | 13.9 (12.3) | ||
| Change | -8.3 (8.7) | -8.5 (8.6) | -7.5 (9.5) | 0.757 | |
| Within P-value | <0.001 | <0.001 | 0.025 | ||
| PROMIS-GH Mental T-score | N | 75 | 57 | 18 | |
| Pre-IOP | 35.3 (7.4) | 34.4 (7.2) | 38.2 (7.7) | ||
| Post-IOP | 36.8 (7.6) | 36.1 (7.6) | 38.9 (7.7) | ||
| Change | 1.5 (7.0) | 1.7 (5.5) | 0.7 (10.6) | 0.686 | |
| Within P-value | 0.072 | 0.021 | 0.794 | ||
| PROMIS-GH Physical T-score | N | 75 | 57 | 18 | |
| Pre-IOP | 32.8 (7.3) | 32.3 (7.2) | 34.2 (7.8) | ||
| Post-IOP | 34.0 (6.4) | 34.1 (6.5) | 33.7 (6.3) | ||
| Change | 1.2 (5.9) | 1.8 (5.0) | -0.5 (8.0) | 0.258 | |
| Within P-value | 0.074 | 0.009 | 0.78 | ||
| PROMIS Fatigue | N | 68 | 52 | 16 | |
| Pre-IOP | 66.8 (7.3) | 67.2 (7.1) | 65.7 (8.0) | ||
| Post-IOP | 65.1 (8.2) | 65.3 (7.8) | 64.4 (9.7) | ||
| Change | -1.7 (5.9) | -1.8 (5.9) | -1.2 (6.0) | 0.731 | |
| Within P-value | 0.02 | 0.029 | 0.418 | ||
| PROMIS Pain Interference | N | 70 | 54 | 16 | |
| Pre-IOP | 68.4 (4.5) | 68.4 (4.6) | 68.4 (4.2) | ||
| Post-IOP | 66.1 (6.3) | 66.4 (6.3) | 65.3 (6.3) | ||
| Change | -2.3 (5.3) | -2.1 (5.5) | -3.1 (5.0) | 0.481 | |
| Within P-value | <0.001 | 0.007 | 0.023 | ||
| PROMIS Physical Function | N | 75 | 58 | 17 | |
| Pre-IOP | 34.0 (5.4) | 34.1 (5.7) | 33.9 (4.6) | ||
| Post-IOP | 35.4 (6.1) | 35.3 (6.3) | 35.9 (5.5) | ||
| Change | 1.4 (4.5) | 1.2 (3.9) | 2.0 (6.4) | 0.64 | |
| Within P-value | 0.009 | 0.019 | 0.215 | ||
| PROMIS Self-Efficacy for Managing Symptoms | N | 72 | 57 | 15 | |
| Pre-IOP | 37.0 (5.6) | 36.9 (5.6) | 37.3 (5.6) | ||
| Post-IOP | 39.7 (7.1) | 40.3 (7.2) | 37.5 (6.9) | ||
| Change | 2.7 (6.4) | 3.3 (6.3) | 0.2 (6.2) | 0.099 | |
| Within P-value | <0.001 | <0.001 | 0.903 | ||
| PROMIS Sleep Disturbance | N | 29 | 20 | 9 | |
| Pre-IOP | 56.4 (8.5) | 57.4 (9.0) | 54.2 (7.3) | ||
| Post-IOP | 57.6 (9.7) | 57.3 (11.3) | 58.1 (5.3) | ||
| Change | 1.2 (8.3) | 0.0 (8.7) | 3.9 (6.9) | 0.206 | |
| Within P-value | 0.453 | 0.98 | 0.128 | ||
| PROMIS Social Role Satisfaction | N | 65 | 51 | 14 | |
| Pre-IOP | 34.2 (6.1) | 34.0 (6.0) | 34.9 (6.7) | ||
| Post-IOP | 36.9 (7.1) | 37.0 (7.2) | 36.2 (6.8) | ||
| Change | 2.7 (6.6) | 3.0 (6.6) | 1.4 (6.8) | 0.422 | |
| Within P-value | 0.002 | 0.002 | 0.466 |
CPNP = Chronic Pain Neuro-Rehabilitation Program, GAD = General Anxiety Disorder, PCS = Patient Catastrophizing Scale; PHQ = Patient Health Questionnaire, PROMIS = Patient Recorded Outcome Measurement Information System.
* P-value ≤ 0.05 is considered statistically significant.
