Neurological Institute Outcomes
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 Patients | Completed IOP | Did Not Attend or Dropped Out of IOP | P Value* | |
---|---|---|---|---|
N | 236 | 60 | 176 | |
Age, mean (SD) | 45.7 (13.4) | 46.4 (13.2) | 43.1 (14.3) | 0.4 |
Female | 194 (82.2%) | 54 (90.0%) | 140 (76.5%) | 0.068 |
Race | 0.787 | |||
White | 180 (76.3%) | 44 (73.3%) | 136 (77.3%) | |
Black | 34 (14.4%) | 10 (16.7%) | 24 (13.6%) | |
Other | 22 (9.3%) | 6 (10.0%) | 16 (9.1%) | |
Marital Status | 0.068 | |||
Married | 110 (46.6%) | 28 (46.7%) | 82 (46.6%) | |
Single | 83 (35.2%) | 27 (45.0%) | 56 (31.8%) | |
Divorced | 30 (12.7%) | 4 (6.7%) | 26 (14.8%) | |
Widowed | 7 (3.0%) | 0 (0.0%) | 7 (4.0%) | |
Missing | 6 (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 Patients | IOP Completers | IOP Non-Completers | Between Group P-value* | ||
---|---|---|---|---|---|
PHQ - 9 Score | N | 158 | 50 | 108 | |
Pre-IOP | 12.9 (6.4) | 13.0 (6.3) | 12.8 (6.4) | ||
Post-IOP | 12.6 (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-value | 0.528 | 0.04 | 0.541 | ||
GAD-7 Score | N | 42 | 21 | 21 | |
Pre-IOP | 12.4 (5.4) | 12.5 (4.9) | 12.2 (6.0) | ||
Post-IOP | 13.3 (4.7) | 13.5 (4.1) | 13.0 (5.3) | ||
Change | 0.9 (4.9) | 1.0 (4.0) | 0.9 (5.7) | 0.926 | |
Within P-value | 0.224 | 0.261 | 0.502 | ||
PCS Total | N | 64 | 44 | 20 | |
Pre-IOP | 28.6 (11.8) | 27.8 (12.0) | 30.6 (11.5) | ||
Post-IOP | 22.7 (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 | <0.001 | 0.396 | ||
PROMIS-GH Mental T-score | N | 174 | 54 | 120 | |
Pre-IOP | 34.7 (7.8) | 35.4 (9.3) | 34.4 (7.0) | ||
Post-IOP | 36.1 (8.4) | 38.0 (9.6) | 35.2 (7.7) | ||
Change | 1.4 (6.8) | 2.7 (5.6) | 0.8 (7.3) | 0.068 | |
Within P-value | 0.009 | 0.001 | 0.23 | ||
PROMIS-GH Physical T-score | N | 174 | 54 | 120 | |
Pre-IOP | 32.0 (6.5) | 33.1 (6.6) | 31.6 (6.4) | ||
Post-IOP | 33.2 (6.9) | 34.3 (7.4) | 32.7 (6.7) | ||
Change | 1.1 (5.7) | 1.3 (5.2) | 1.1 (5.9) | 0.838 | |
Within P-value | 0.009 | 0.077 | 0.046 | ||
PROMIS Fatigue | N | 141 | 44 | 97 | |
Pre-IOP | 65.8 (8.7) | 66.0 (7.7) | 65.7 (9.1) | ||
Post-IOP | 64.9 (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-value | 0.203 | 0.021 | 0.998 | ||
PROMIS Pain Interference | N | 145 | 44 | 101 | |
Pre-IOP | 70.1 (5.6) | 68.3 (5.7) | 70.8 (5.3) | ||
Post-IOP | 68.0 (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 | <0.001 | 0.001 | 0.019 | ||
PROMIS Physical Function | N | 132 | 42 | 90 | |
Pre-IOP | 32.3 (5.7) | 33.2 (5.5) | 31.8 (5.7) | ||
Post-IOP | 33.2 (6.2) | 34.0 (7.1) | 32.8 (5.8) | ||
Change | 0.9 (4.6) | 0.8 (4.9) | 1.0 (4.5) | 0.838 | |
Within P-value | 0.022 | 0.293 | 0.041 | ||
PROMIS Self-Efficacy for Managing Symptoms | N | 102 | 49 | 53 | |
Pre-IOP | 37.5 (5.7) | 38.0 (4.9) | 37.1 (6.5) | ||
Post-IOP | 39.7 (6.4) | 40.0 (5.1) | 39.5 (7.4) | ||
Change | 2.1 (5.4) | 2.0 (4.8) | 2.3 (6.0) | 0.736 | |
Within P-value | <0.001 | 0.007 | 0.006 | ||
PROMIS Sleep Disturbance | N | 132 | 41 | 91 | |
Pre-IOP | 61.2 (9.5) | 60.1 (10.4) | 61.7 (9.1) | ||
Post-IOP | 58.2 (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 | <0.001 | 0.08 | 0.002 | ||
PROMIS Social Role Satisfaction | N | 125 | 44 | 81 | |
Pre-IOP | 35.0 (7.3) | 36.7 (6.6) | 34.0 (7.5) | ||
Post-IOP | 37.1 (7.7) | 37.7 (8.1) | 36.8 (7.5) | ||
Change | 2.2 (7.8) | 1.0 (7.2) | 2.8 (8.0) | 0.216 | |
Within P-value | 0.002 | 0.349 | 0.003 |
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.