Treatment outcome of chronic non-malignant pain patients managed in a Danish multidisciplinary pain centre compared to general practice: a randomised controlled trial

This randomised controlled study investigated the effect of outpatient multidisciplinary pain centre treatment (MPT) compared with treatment by a general practitioner after initial supervision by a pain specialist (GP-group) and with a group of patients waiting for 6 months before treatment was initiated (WL-group). One-hundred-and-eighty-nine chronic non-malignant pain patients were studied. At referral, and after 3 and 6 months patients filled in questionnaires evaluating pain intensity, health related quality of life (HRQL) and use of analgesics. HRQL was evaluated using the Medical Outcome Study-Short Form (SF-36), the Hospital Anxiety and Depression scale (HAD) and the Psychological General Well-being Scale (PGWB). After 6 months patients allocated,to MPT (n = 63) reported statistically significant reduction in pain intensity (VAS-score, P < 0.001), improvement in psychological :well-being (PGWB, P < 0.001. quality of sleep (P < 0.05) and physical functioning (SF-36-Phycical Functioning, P < 0.05). No improvements were seen in the GP-group (n = 63). In the WL-group (n = 63) a statistically significant deterioration was observed in PGWB-scores, HAD-scores and in 6 of 8 SF-36-subscores (P less than or equal to 0.05). A reduction in use of opioids administered on demand was obtained in the-group receiving MPT (P < 0.001). In the MPT- and GP-grougs a decrease in the use of short acting opioids was observed (P < 0.01). No change in use of analgesics was seen in the Wt-group. The study showed that (i) in the MPT-,group there was a significant reduction in pain intensity and improvement of HRQL compared to the WL-group and (ii) the mere establishment of a pain diagnosis and a pain management plan by a pain specialist was not sufficient to enable the referring GP to manage severely chronic pain patients. (C) 2000 International Association for the Study of Pain. Published by Elsevier Science B.V.