Scholten, Paul

ABSTRACT This study assessed the level of agreement of perceived improvements among pediatric patients with chronic pain and their parents following an interdisciplinary pain management program. This is a retrospective chart review of a heterogeneous group of pediatric patients with chronic pain who completed an interdisciplinary pain management program (IPMP) and their parents ( N = 172 pairs). The IPMP took place in an outpatient pain management center affiliated with an academic rehabilitation hospital. The outcome measures included the Multidimensional Patient Impression of Change (MPIC) and the MPIC parent version were administered post‐treatment. The levels of agreement on the MPIC were analyzed between child and parent using the free‐marginal kappa statistic. The majority of both the parents and the children evaluated the patients to be much or very much improved in six of the eight domains assessed. The levels of agreement in the ratings were fair to moderate among the patient–parent dyads. Parents endorsed significantly higher levels of improved overall pain and mood than their child did, whereas the patients reported greater levels of improved ability to cope with pain than their parents did. Both the patients and their parents reported high levels of perceived improvement following the IPMP. However, there were some differences in their ratings of improvements in overall pain, mood, and ability to cope with pain. Given that some of the perceptions were discrepant, it is recommended that feedback be obtained from the patient and their parent.

Abstract Clinical and translational research is important for health care and the growth of medical specialties. Physical medicine and rehabilitation offers many opportunities for research, but research growth in physical medicine and rehabilitation is lacking, and research resources and productivity vary across academic physical medicine and rehabilitation departments across North America. The Physiatric Research Consulting Program was developed by the Association of Academic Physiatrists to provide customized recommendations to enhance research capacity and productivity in physical medicine and rehabilitation departments. This report outlines the three components of the Physiatric Research Consulting Program, including a previsit needs assessment, an in-person visit, and a postvisit follow-up final report. The report also provides a qualitative assessment of the impact of the Physiatric Research Consulting Program, with general themes of feedback, site visit evaluations, and final report evaluations. The Physiatric Research Consulting Program was found to be valuable in identifying gaps and needs for physical medicine and rehabilitation departments, providing outside perspectives, and energizing faculty toward research growth in their departments.

Abstract Objective The present study examined pre- to post-treatment changes in volumes for brain structures known to be associated with pain processing (thalamus, caudate, putamen, pallidum, hippocampus, amygdala, and accumbens) following an interdisciplinary pain management program. Design Twenty-one patients participating in a four-week interdisciplinary pain management program completed the study. The program consisted of individual and group therapies with the following disciplines: physical therapy, occupational therapy, pain psychology, biofeedback/relaxation training, nursing lectures, and medical management. All patients underwent functional magnetic resonance imaging of the brain before the start and at completion of the program. They also completed standard outcome measures assessing pain, symptoms of central sensitization, disability, mood, coping, pain acceptance, and impressions of change. Results Our results showed a significant increase in total brain volume, as well as increased volumes in the thalamus, hippocampus, and amygdala. As expected, we also found significant improvements in our standard outcome measures. The majority of patients rated themselves as much or very much improved. The increase in volume in the hippocampus was significantly associated with patient perceptions of change. However, the correlations were in the unexpected direction, such that greater increases in hippocampal volume were associated with perceptions of less improvement. Further exploratory analyses comparing patients by their opioid use status (use vs no use) showed differential program effects on volume increases in the hippocampus and amygdala. Conclusions These findings show that a four-week interdisciplinary pain management program resulted in changes in the brain, which adds objective findings further demonstrating program efficacy.