Rheumatology Advance Access originally published online on March 27, 2008
Rheumatology 2008 47(5):670-678; doi:10.1093/rheumatology/ken021
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Multidisciplinary treatment for chronic pain: a systematic review of interventions and outcomes
1Department of Rheumatology and Institute of Physical Medicine, University Hospital Zurich and 2Federal Invalidity Insurance, Bern, Switzerland.
Correspondence to: H. Sprott, Department of Rheumatology and Institute of Physical Medicine, University Hospital Zurich, Gloriastr. 25, CH-8091 Zurich, Switzerland. E-mail: haiko.sprott{at}usz.ch
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Abstract |
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Objectives. To provide an overview of the effectiveness of multidisciplinary treatments of chronic pain and investigate about their differential effects on outcome in various pain conditions and of different multidisciplinary treatments, settings or durations.
Methods. In this article, the authors performed a systematic review of all currently available randomized controlled trials (RCTs) fulfilling the inclusion criteria, by using a recently developed rating system aimed to assess the strength of evidence with regard to the methodological quality of the trials.
Results. Compared with other non-disciplinary treatments, moderate evidence of higher effectiveness for multidisciplinary interventions was shown. In contrast to no treatment or standard medical treatment, strong evidence was detected in favour of multidisciplinary treatments. The evidence that comprehensive inpatient programmes were more beneficial that outpatient programmes was moderate. Fibromyalgia and chronic back pain patients tended to profit more substantially than patients with diverse origins or chronic pain diagnoses. No evidence was found that treatment variables, such as duration or programme components, were influential for the success of the intervention.
Conclusion. A standard of multidisciplinary programmes should be internationally established to guarantee generally good outcomes in the treatment of chronic pain. Our results highlight the lack of quality of design, execution or reporting of many of the RCTs included in this article. Future studies should more specifically focus on differential effects of treatment components and patient variables, allowing the identification of subgroups, which most probably would profit from multidisciplinary pain programmes.
KEY WORDS: Back pain, Chronic pain, Fibromyalgia, Multidisciplinary treatment, Systematic review
Submitted 10 October 2007;
revised version accepted 9 January 2008.
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