Intervenção multimodal em grupo para a dor crônica e seus efeitos na intensidade da dor, interferência da dor na qualidade de vida e bem-estar emocional

Abstract

Background: Chronic pain (CP) is a common cause of disability and distress, needing early and effective treatment to mitigate its impact on pain in daily life activities. Chronic pain self-management programs (CPSMP) carried out by healthcare professionals have demonstrated efficacy in reducing pain and enhancing quality of life (QOL). Objective: This quasi-experimental study aimed to compare the effect of a multimodal CPSMP based on cognitive-behavioral therapy and exercises associated to pharmacological treatment with a conventional treatment group (CTG), receiving only pharmacological treatment, on pain intensity (PI), pain interference in QOL, and emotional aspects. Methods: A total of 206 patients (mostly female; age range: 40-59 years) with CP participated in this study. The CTG (n=103) formed by the wait list to the CPSMP was used as control. The CPSMP (n=103) was carried out in groups of 8 o 10 patients in weekly sessions lasting 2 hours each, conducted over 6 weeks. Pain intensity and interference with QOL domains were accessed using the Brief Pain Inventory Scale (BPI), with a minimal clinically important difference of -1 point on the visual analog pain scale indicating effective change. Anxiety and depression were measured using the Hospital Anxiety and Depression Scale (HADS) considering change in categorical symptoms as parameter for effective improvement. The Chi-square test and the Mann-Whitney U-teste were used to compare variables between groups in baseline moment. The t-student test was used to compare the difference in averages between groups from baseline to post treatment. Results: The study revealed that participants in the CPSMP group exhibited a significant decrease in the intensity of 'worst pain' (-1.09±3.11, p<0.001) and 'pain interference' across QOL domains (-1.78±3.31 to -2.44±4.56, p<0.001) with an average effect size of 0.68 (range=0.54-0.88) for these gains. As for anxiety and depression, compared to de CTG, patients that participated in de CPSMP had a change in their perception of emotional distress with an average effect size of 0.52 (range=0.43-0.60) for this gain. Compared to the CTG, the self-management group had a 3 times higher chance to reduce in at least -1 point in their worst pain (55% vs 30%; odds ration [OR], 2.81 [95% confidence interval (CI), 1.58 to 5.01]) and a 2 to 3 times higher chance (CI 95% 1.06-3.28 and 1.7-5.37) to reduce clinical symptoms of anxiety and depression in the post treatment. Conversely, the CTG showed no significant improvements across measured variables. Conclusion: The multimodal CPSMP was effective in reducing pain and improving quality of life and emotional well-being among patients with CP, suggesting that CPMSP may be more effective than pharmacological treatment alone.