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 PatientsCompleted IOP

Did Not Attend or

Dropped Out of IOP

P Value*
N31698218
Age, mean (SD)48.0 (13.9)48.1 (13.5)47.9 (14.1)0.918
Female243 (76.9%)76 (77.6%)167 (76.6%)0.886
Race0.024
White246 (77.8%)67 (68.4%)179 (82.1%)
Black41 (13.0%)18 (18.4%)23 (10.6%)
Other29 (9.2%)13 (13.3%)16 (7.9%)
Marital Status0.9
Married153 (48.4%)45 (45.9%)108 (49.5%)
Single110 (34.8%)37 (37.8%)73 (33.5%)
Divorced45 (14.2%)13 (13.3%)32 (14.7%)
Widowed5 (1.6%)2 (2.0%)3 (1.4%)
Missing3 (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 PatientsIOP CompletersIOP Non-CompletersBetween Group P-value*
PHQ - 9 ScoreN735518
Pre-IOP13.7 (6.7)14.7 (6.4)10.8 (6.8)
Post-IOP10.9 (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<0.0010.254
GAD-7 ScoreN42339
Pre-IOP13.6 (5.7)14.9 (4.1)9.1 (8.3)
Post-IOP11.6 (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-value0.0080.0030.714
PCS HelplessnessN604812
Pre-IOP13.4 (6.0)14.0 (5.9)11.1 (6.3)
Post-IOP9.3 (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<0.0010.115
PCS MagnificationN604911
Pre-IOP5.4 (3.4)5.8 (3.1)3.6 (4.0)
Post-IOP3.8 (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<0.0010.061
PCS RuminationN604812
Pre-IOP9.6 (4.5)10.4 (4.2)6.3 (4.5)
Post-IOP6.9 (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<0.0010.529
PCS TotalN584711
Pre-IOP28.4 (13.2)30.1 (12.3)21.5 (15.3)
Post-IOP20.1 (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<0.0010.025
PROMIS-GH Mental T-scoreN755718
Pre-IOP35.3 (7.4)34.4 (7.2)38.2 (7.7)
Post-IOP36.8 (7.6)36.1 (7.6)38.9 (7.7)
Change1.5 (7.0)1.7 (5.5)0.7 (10.6)0.686
Within P-value0.0720.0210.794
PROMIS-GH Physical T-scoreN755718
Pre-IOP32.8 (7.3)32.3 (7.2)34.2 (7.8)
Post-IOP34.0 (6.4)34.1 (6.5)33.7 (6.3)
Change1.2 (5.9)1.8 (5.0)-0.5 (8.0)0.258
Within P-value0.0740.0090.78
PROMIS FatigueN685216
Pre-IOP66.8 (7.3)67.2 (7.1)65.7 (8.0)
Post-IOP65.1 (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-value0.020.0290.418
PROMIS Pain InterferenceN705416
Pre-IOP68.4 (4.5)68.4 (4.6)68.4 (4.2)
Post-IOP66.1 (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<0.0010.0070.023
PROMIS Physical FunctionN755817
Pre-IOP34.0 (5.4)34.1 (5.7)33.9 (4.6)
Post-IOP35.4 (6.1)35.3 (6.3)35.9 (5.5)
Change1.4 (4.5)1.2 (3.9)2.0 (6.4)0.64
Within P-value0.0090.0190.215
PROMIS Self-Efficacy for Managing SymptomsN725715
Pre-IOP37.0 (5.6)36.9 (5.6)37.3 (5.6)
Post-IOP39.7 (7.1)40.3 (7.2)37.5 (6.9)
Change2.7 (6.4)3.3 (6.3)0.2 (6.2)0.099
Within P-value<0.001<0.0010.903
PROMIS Sleep DisturbanceN29209
Pre-IOP56.4 (8.5)57.4 (9.0)54.2 (7.3)
Post-IOP57.6 (9.7)57.3 (11.3)58.1 (5.3)
Change1.2 (8.3)0.0 (8.7)3.9 (6.9)0.206
Within P-value0.4530.980.128
PROMIS Social Role SatisfactionN655114
Pre-IOP34.2 (6.1)34.0 (6.0)34.9 (6.7)
Post-IOP36.9 (7.1)37.0 (7.2)36.2 (6.8)
Change2.7 (6.6)3.0 (6.6)1.4 (6.8)0.422
Within P-value0.0020.0020.466

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.