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 all patient reported outcomes except for anxiety (GAD-7) (for which sample size was much smaller due to lower completion rates). Among patients who did not complete the IOP, there was statistically significant improvement in PROMIS Fatigue, PROMIS Pain Interference, and PROMIS Social Satisfaction, likely attributed to other treatment effects that were 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 for the majority of the pain outcomes measures (PROMIS Global Health Physical, PROMIS Global Health Mental, PROMIS Pain Interference, PROMIS Physical Function, PCS Total Score and subscores, and depression (PHQ-9 total score)).

Demographics of Patients Recommended for CPNP
All PatientsCompleted IOP

Did Not Attend or

Dropped Out of IOP

P Value*
N31698218
Age, mean (SD)48 (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%)18 (18.4%)23 (10.6%)
Other29 (9.2%)13 (13.3%)16 (7.3%)
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%)3 (1.4%)
Missing3 (0.9%)1 (1%)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

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

* P-value ≤ 0.05 is considered statistically significant.

Outcomes in CPNP Graduates
Completed IOPDid not Attend Or Dropped out of IOPBetween Group P-value*
PROMIS GLOBAL Mental HealthPre-ClassN95163
Mean34.6 (7.2)34.9 (8.2)
Post-ClassN79177
Mean38.8 (9.2)34.9 (7.9)
ChangeN78133
Mean4.1 (7.2)0.9 (7.2)0.002*
Within-Group P-value< 0.0010.13
PROMIS GLOBALPhysical HealthPre-ClassN95164
Mean32.5 (5.5)31.9 (6.6)
Post-ClassN80177
Mean36.2 (6.5)32.2 (6.6)
ChangeN79134
Mean4.0 (6.3)0.4 (5.5)< 0.001*
Within-Group P-value< 0.0010.39
PROMIS FatiguePre-ClassN94126
Mean65.2 (7.7)67.2 (8.2)
Post-ClassN73184
Mean61.7 (8.1)66.3 (8.0)
ChangeN71112
Mean-3.8 (6.5)-2.0 (7.3)0.101
Within-Group P-value< 0.0010.004
PROMIS Pain InterferencePre-ClassN94135
Mean69.8 (5.0)70.7 (5.4)
Post-ClassN66182
Mean65.7 (6.1)69.9 (5.6)
ChangeN65116
Mean-4.0 (6.0)-1.0 (5.0)< 0.001*
Within-Group P-value< 0.0010.029
PROMIS Physical FunctionPre-ClassN86134
Mean33.1 (5.4)32.4 (5.5)
Post-ClassN67126
Mean34.7 (5.8)33.5 (6.0)
ChangeN6290
Mean2.3 (3.8)0.6 (5.4)0.022*
Within-Group P-value< 0.0010.291
PROMIS Social Role SatisfactionPre-ClassN93110
Mean36.1 (6.9)34.0 (7.1)
Post-ClassN74178
Mean38.8 (8.1)35.6 (7.0)
ChangeN7294
Mean2.8 (8.4)1.8 (7.1)0.43
Within-Group P-value0.0070.015
PCS Total ScorePre-ClassN8828
Mean30.7 (12.2)29.6 (12.9)
Post-ClassN51160
Mean17.2 (12.7)28.0 (12.6)
ChangeN4521
Mean-11.1 (11.3)-0.5 (9.6)< 0.001*
Within-Group P-value< 0.0010.805
PHQ-9 ScorePre-ClassN95143
Mean13.9 (5.5)13.3 (6.5)
Post-ClassN74184
Mean9.6 (6.2)13.4 (6.6)
ChangeN72128
Mean-4.8 (5.5)0.1 (5.8)< 0.001*
Within-Group P-value< 0.0010.844
GAD-7 ScorePre-ClassN3539
Mean10.9 (5.6)12.1 (5.6)
Post-ClassN2448
Mean9.0 (6.4)12.3 (5.5)
ChangeN1321
Mean-1.6 (4.3)0.6 (4.6)0.171
Within-Group P-value0.1960.579
PROMIS Self-Efficacy Managing Symptoms T-ScorePre-ClassN9067
Mean37.3 (6.2)36.0 (5.7)
Post-ClassN68172
Mean41.4 (5.7)37.4 (6.2)
ChangeN6358
Mean3.9 (5.3)1.6 (5.4)0.017*
Within-Group P-value< 0.0010.033

CPNP = Chronic Pain Neuro-Rehabilitation Program

* 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

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

Changes in Depression

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

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