Resiliency is a Predictor of Clinical Outcomes in a Chronic Pain Cohort.

Abstract

Multidimensional strategies to improve pain have advanced the understanding of pain and pain treatment, yet the examination of biopsychosocial factors and associated treatments within pain management has not reached the mainstream. The objective of this study was to explore whether psychological variables added to routinely collected medical information were associated with clinical outcomes and the need for additional treatments after an initial chronic pain intervention. This prospective, observational study recruited patients during their initial pain management visits and followed them until they returned to the clinic for additional pain management. A private, multispecialty orthopedic clinic in Tallahassee, Florida. Patients were seeking treatment for their chronic pain. They completed a series of psychological evaluations, including the Patient Health Questionnaire 9 (PHQ-9), Generalized Anxiety Disorder Scale 7 (GAD-7), Avoidance-Endurance Questionnaire (AEQ), and Connor-Davidson Resilience Scale 10 (CD-RISC-10), in addition to answering lifestyle/behavioral questions. Chart reviews were performed at least one year from the patients' initial visits to understand the response to initial treatment and subsequent clinical management of their pain conditions. One hundred fifty-two patients completed the full assessment, and 118 returned at least once to the clinic for continued medical care and were included in the models. A previous history of opioid use at the initial visit was a significant positive predictor of change in pain (P = 0.049). The CD-RISC-10 score was a significant negative predictor of the need for additional treatment at the patient's follow-up visit (P = 0.040). Thirteen percent of the cohort reported at least moderate symptoms of anxiety, and 26% of the cohort reported at least moderate symptoms of depression. The limitations of this study were a lack of quantified opioid use and a reliance on self-reported measures. The inclusion of a resiliency measure along with established psychological instruments appears to add clinical value when managing patients with chronic pain. This study adds to the growing body of evidence that depicts resiliency as an important predictor of clinical outcomes.