• John Kowal, Keith G Wilson, Celia M Geck, Peter R Henderson, and Joyce L D'Eon.
• The Ottawa Hospital Rehabilitation Centre, Ottawa, Ontario, Canada. jkowal@ottawahospital.on.ca
• Pain Res Manag. 2011 Nov 1;16(6):451-6.

BackgroundThere is good support for the effectiveness of interdisciplinary chronic pain management programs in improving functional outcomes; however, relatively little is known about patients who report deterioration following participation in such programs.ObjectivesThe present retrospective study investigated patients' reports of increased pain severity during participation in a cognitive-behaviourally oriented, outpatient treatment for chronic pain.MethodsParticipants (n=280) completed a four-week, group-based, interdisciplinary chronic pain self-management program at a rehabilitation hospital. They completed pre- and post-treatment questionnaires, which included global change ratings of pain severity and clinically-relevant measures, including pain intensity ratings, functional limitations, pain catastrophizing and self-efficacy.ResultsStatistically significant pre-post improvements were observed for all study variables. Almost all patients reported global improvement overall. Nevertheless, a subset of patients (n=99) reported increased pain severity on global ratings. These individuals were characterized by lower self-efficacy at baseline.ConclusionsParticipants endorsed significant pre- and post-treatment improvements in all domains. Nevertheless, some participants reported deterioration. The findings shed light on variables associated with negative treatment outcomes and have practical applications for interdisciplinary chronic pain management programs.

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