Predictors of Attrition in an Interdisciplinary Pain Management Program




Chong, Jeanette Lee

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BACKGROUND: Chronic pain is a debilitating condition that affects millions of adults in the United States. In recent years, particularly with the growing concerns about opioid use, there has been a steady increase in the use of interdisciplinary pain programs (IPP) to treat chronic pain. The effectiveness of such programs has been well-documented; however, attrition has also been identified as a neglected topic in outcome studies. OBJECTIVE: This study aimed to investigate the extent to which demographic/clinical characteristics predict attrition in an IPP. Study aims also included examining longitudinal changes in score for the completion group for a variety of clinical measures, and an exploratory analysis comparing changes between non/completion groups. METHOD: Participants included one hundred and seventy-eight patients receiving treatment for chronic pain conditions in an IPP at the Eugene McDermott Center for Pain Management at UT Southwestern Medical Center. Participants completed measures related to pain and psychosocial functioning at baseline, mid-intervention (2 weeks post-enrollment), and post-intervention (4 weeks post-enrollment). ANALYSIS: This study used logistic regression analyses to identify variables most predictive of attrition in five domains: 1) selected demographic variables, 2) number of medical diagnoses [psychiatric and non-psychiatric], 3) opioid use/risk of misuse, 4) pain-related cognition and behavior, and 5) physical, social, and mental well-being. Mixed models analyses were also conducted to examine longitudinal changes in score on a variety of clinical measures for the completion group. RESULTS: Participants who were of younger age, unemployed, and not on opioids pre-intervention had higher odds of dropping out. The completion group demonstrated improvement pre- to post-intervention on each of the measures assessed in the 1) pain-related cognition and behavior domain and 2) physical, social, and mental well-being domain, except for one measure. DISCUSSION: Mean age of non-completers was 48.72 years (SD = 13.44); these patients may have had difficulty with program compliance due to more outside stressors (e.g., younger children, demanding jobs). Participants may have been unemployed due to a number of potential contributing factors (e.g., lack of transportation, lower motivation, physical mobility), which would create barriers to program completion. Previous findings suggest opioid dependency contributes to higher odds of dropout; however, results from the current study suggest pre-intervention opioid use--not dependency--does not contribute to higher odds of attrition.

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