Patients with chronic pain : quantitative and qualitative studies of treatment or rehabilitation at a pain clinic

Background and aim: Chronic pain is a major problem, often with comorbidity of insomnia, mental disorders and limitations in function, activity and participation, all leading to poor quality of life. Patients describe their pain as unpredictable and ‘invisible’ thus influencing being and communication. Patients with chronic pain are treated in primary care, pain clinics and rehabilitation units. Pain-clinic patients represent a wide range of diagnoses and knowledge of these settings is limited. The overall aim of the work presented in this thesis was to explore aspects of living with chronic pain among patients attending a pain clinic. Methods and results: Three studies resulting in four papers were performed at a pain clinic where patient-adapted treatment alternatives included conventional, mainly pharmacological, pain treatment (CPT) and a team-based multimodal rehabilitation programme (MMR). In Study I, interviews with 14 informants (13 female, age 23-77) who had participated in MMR one year earlier were analysed using content analysis. The core theme “Change is possible” and the themes “A life ruled by pain” (the situation before rehabilitation), “The penny’s dropped” (experience during rehabilitation) and “Live a life, not only survive” (the situation at the time of the interviews) emerged from the data. The process describes how the informants could integrate earlier disabling symptoms into a well-functioning lifestyle (Paper I). Study II was a longitudinal, observational study of patients assessed and treated. Patientreported outcome measures (PROM) of health-related quality of life (EQ-5D), pain (VAS), anxiety and depression (HADS), insomnia (ISI), pain related disability (PDI), kinesiophobia (TSK) and sense of coherence (SOC) were collected at the first visit and one year later. Data were analysed according to the treatment alternatives: MMR-group (n= 42) (Paper II) and CPT-group (n=271) as well as patients assessed and referred (AOgroup, n=47) (Paper III). The baseline showed substantial problems in PROM with the worst state in the MMR-group. Significant improvements (p