Pain

Cleveland Clinic Chronic Pain Rehabilitation Program

The Cleveland Clinic Chronic Pain Rehabilitation Program (CPRP) is a comprehensive interdisciplinary program designed to treat patients with disabling chronic pain. The CPRP treats approximately 200 patients per year and has been in existence since 1979. Duration of treatment is 3 to 4 weeks from 7:30 AM to 5:00 PM Monday through Friday, and includes medication management, individual and group psychotherapy, family therapy, physical and occupational therapy, substance use education, weaning from habituating medications, and optional monthly aftercare.

Change in Pain Intensity Ratings in CPRP Patients (N = 140)

2018

CPRP = Chronic Pain Rehabilitation Program

Of the 140 patients who completed the CPRP in 2018, 139 provided both admission and discharge information about their pain intensity on a 0 to 10 scale (0 = no pain, 10 = worst possible pain), and 34 provided data at 6-month follow-up. Clinically significant change was defined as ≥ 2.5 points.¹⁻²

Change in Depression and Anxiety Symptoms in CPRP Patients (N = 140)

2018

CPRP = Chronic Pain Rehabilitation Program

Of the 140 patients who successfully completed the CPRP in 2018, 139 provided admission and discharge information about their symptoms of depression and anxiety as measured by the Depression Anxiety Stress Scale (DASS-21),³ and 34 provided 6-month follow-up information. Higher scores indicate more severe symptoms. Clinically significant change cutoffs for DASS-21 have not been established, but a cutoff score of ≥ 7 points was used for each subscale in these analyses. Patients whose change was < 7 points were deemed stable.

Change in Functioning in CPRP Patients (N = 140)

2018

CPRP = Chronic Pain Rehabilitation Program

Of the 140 patients who successfully completed the CPRP, 138 provided admission and discharge information about their functioning as measured by the PDI, and 33 provided 6-month follow-up information. Higher scores on the 0–70 scale indicate greater disability. Clinically significant change was defined as ≥ 9 points.⁴

Change in Opioid Use in CPRP Patients (N = 140)

2018

CPRP = Chronic Pain Rehabilitation Program

At the time of CPRP admission, 52 of the 140 patients who completed the program were prescribed chronic opioid therapy. By discharge from CPRP, all 52 of these patients were fully weaned. This does not include 1 patient who was admitted and discharged from the program on sublingual buprenorphine and naloxone. Six-month follow-up data were available for 11 weaned patients, and 9 (81.8%) of them reported they were still opioid-free.

References
  1. Farrar JT, Pritchett YL, Robinson M, Prakash A, Chappell A. The clinical importance of changes in the 0 to 10 numeric rating scale for worst, least, and average pain intensity: analyses of data from clinical trials of duloxetine in pain disorders. J Pain. 2010 Feb;11(2):109-118.
  2. Salaffi F, Stancati A, Silvestri CA, Ciapetti A, Grassi W. Minimal clinically important changes in chronic musculoskeletal pain intensity measured on a numerical rating scale. Eur J Pain. 2004 Aug;8(4):283-291.
  3. Lovibond SH, Lovibond PF. Manual for the depression anxiety stress scales. 2nd Ed. Sydney, Australia: Psychology Foundation of Australia, 1995.
  4. Soer R, Reneman MF, Vroomen PC, Stegeman P, Coppes MH. Responsiveness and minimally clinically important change of the Pain Disability Index in patients with chronic back pain. Spine, 2012 Apr 15;37(8):711-715.