REVIEW - Multidisciplinary treatment for chronic pain: a systematic review of interventions and outcomes

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Rheumatology Advance Access originally published online on March 27, 2008

Rheumatology 2008 47(5):670-678; doi:10.1093/rheumatology/ken021

Multidisciplinary treatment for chronic pain: a systematic review of

interventions and outcomes

L. Scascighini1, V. Toma1, S. Dober-Spielmann2 and H. Sprott1

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@...

Abstract

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.

http://rheumatology.oxfordjournals.org/cgi/content/abstract/47/5/670?etoc

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