Pain

Outcomes in Chronic Pain Neuro-Rehabilitation Program

Cleveland Clinic's Chronic Pain Neuro-Rehabilitation Program (CPNP) is an intensive outpatient program (IOP) 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 a 1-week intensive physical and occupational therapy program, which is delivered in person.

Among patients who completed the IOP, there were statistically and clinically meaningful improvements in depression, pain catastrophizing, FROMIS 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. Importantly, when comparing whether unadjusted change in score was different between the 2 groups, the group that completed the IOP had significantly more improvement in depression scores than patients who did not complete the program.

Demographics of Patients Recommended for CPNP
All PatientsCompleted IOP

Did Not Attend or

Dropped Out of IOP

P Value*
N23660176
Age, mean (SD)45.7 (13.4)46.4 (13.2)43.1 (14.3)0.4
Female194 (82.2%)54 (90.0%)140 (76.5%)0.068
Race0.787
White180 (76.3%)44 (73.3%)136 (77.3%)
Black34 (14.4%)10 (16.7%)24 (13.6%)
Other22 (9.3%)6 (10.0%)16 (9.1%)
Marital Status0.068
Married110 (46.6%)28 (46.7%)82 (46.6%)
Single83 (35.2%)27 (45.0%)56 (31.8%)
Divorced30 (12.7%)4 (6.7%)26 (14.8%)
Widowed7 (3.0%)0 (0.0%)7 (4.0%)
Missing6 (2.5%)1 (1.7%)5 (2.8%)
Median Income by ZIP Code (x $1000), mean (SD)52.5 (17.6)53.0 (16.4)52.4 (18.0)0.796

CPNP = Chronic Pain Neuro-Rehabilitation Program, IOP = intensive outpatient program.

Outcomes in CPNP Graduates
All PatientsIOP CompletersIOP Non-CompletersBetween Group P-value*
PHQ - 9 ScoreN15850108
Pre-IOP12.9 (6.4)13.0 (6.3)12.8 (6.4)
Post-IOP12.6 (7.0)11.4 (7.3)13.2 (6.8)
Change-0.3 (5.8)-1.7 (5.6)0.3 (5.8)0.04
Within P-value0.5280.040.541
GAD-7 ScoreN422121
Pre-IOP12.4 (5.4)12.5 (4.9)12.2 (6.0)
Post-IOP13.3 (4.7)13.5 (4.1)13.0 (5.3)
Change0.9 (4.9)1.0 (4.0)0.9 (5.7)0.926
Within P-value0.2240.2610.502
PCS TotalN644420
Pre-IOP28.6 (11.8)27.8 (12.0)30.6 (11.5)
Post-IOP22.7 (14.4)20.4 (13.7)27.8 (15.0)
Change-5.9 (12.8-7.3 (12.0)-2.8 (14.2)0.217
Within P-value<0.001<0.0010.396
PROMIS-GH Mental T-scoreN17454120
Pre-IOP34.7 (7.8)35.4 (9.3)34.4 (7.0)
Post-IOP36.1 (8.4)38.0 (9.6)35.2 (7.7)
Change1.4 (6.8)2.7 (5.6)0.8 (7.3)0.068
Within P-value0.0090.0010.23
PROMIS-GH Physical T-scoreN17454120
Pre-IOP32.0 (6.5)33.1 (6.6)31.6 (6.4)
Post-IOP33.2 (6.9)34.3 (7.4)32.7 (6.7)
Change1.1 (5.7)1.3 (5.2)1.1 (5.9)0.838
Within P-value0.0090.0770.046
PROMIS FatigueN1414497
Pre-IOP65.8 (8.7)66.0 (7.7)65.7 (9.1)
Post-IOP64.9 (9.1)63.2 (7.9)65.7 (9.5)
Change-0.9 (8.1)-2.8 (7.7)0.0 (8.2)0.054
Within P-value0.2030.0210.998
PROMIS Pain InterferenceN14544101
Pre-IOP70.1 (5.6)68.3 (5.7)70.8 (5.3)
Post-IOP68.0 (7.2)65.1 (7.2)69.3 (6.9)
Change-20. (6.4)-3.2 (6.2)-1.5 (6.5)0.143
Within P-value<0.0010.0010.019
PROMIS Physical FunctionN1324290
Pre-IOP32.3 (5.7)33.2 (5.5)31.8 (5.7)
Post-IOP33.2 (6.2)34.0 (7.1)32.8 (5.8)
Change0.9 (4.6)0.8 (4.9)1.0 (4.5)0.838
Within P-value0.0220.2930.041
PROMIS Self-Efficacy for Managing SymptomsN1024953
Pre-IOP37.5 (5.7)38.0 (4.9)37.1 (6.5)
Post-IOP39.7 (6.4)40.0 (5.1)39.5 (7.4)
Change2.1 (5.4)2.0 (4.8)2.3 (6.0)0.736
Within P-value<0.0010.0070.006
PROMIS Sleep DisturbanceN1324191
Pre-IOP61.2 (9.5)60.1 (10.4)61.7 (9.1)
Post-IOP58.2 (9.2)57.3 (9.1)58.7 (9.2)
Change-3.0 (9.5)-2.8 (10.1)-3.1 (9.2)0.899
Within P-value<0.0010.080.002
PROMIS Social Role SatisfactionN1254481
Pre-IOP35.0 (7.3)36.7 (6.6)34.0 (7.5)
Post-IOP37.1 (7.7)37.7 (8.1)36.8 (7.5)
Change2.2 (7.8)1.0 (7.2)2.8 (8.0)0.216
Within P-value0.0020.3490.003

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.

Changes in Pain Catastrophizing

Comparison between patients who completed the CPNP vs those who did not participate

CPNP = Chronic Pain Neuro-Rehabilitation Program, PCS = Pain Catastrophizing Scale.

Changes in Depression

Comparison between patients who completed the CPNP vs those who did not participate

CPNP = Chronic Pain Neuro-Rehabilitation Program, PHQ-9 = Patient Health Questionnaire.