Personality disorders and outcome after multidisciplinary pain therapy

Abstract

Objectives

Interdisciplinary treatment programmes are the gold standard for patients suffering from chronic pain. However, several patient-related factors seem to influence the patients’ outcome. The aim of our study was to inquire whether patients with personality disorders (PD) might benefit less from an interdisciplinary treatment programme compared to patients without PD.

Methods

A prospective, observational study with chronic pain patients attending a 5-week interdisciplinary treatment programme was performed. Main outcome parameters were psychological stabilization and pain intensity before and after the programme.

Results

Out of the 104 included patients, 71 (68.3%) showed personality accentuations and 16 (15.4%) were diagnosed with PDs. PDs were mostly classified as histrionic, followed by borderline and narcistic personality. Patients diagnosed with histrionic accentuation showed a significantly better treatment response in terms of pain. Reduction in ADS (Allgemeine Depressionsskala – depression scale) was 3.4 in patients with PD and 11.1 in those without PD. Borderline patients showed a significant increase of ADS (by 2.0; p < 0.05) after programme completion.

Discussion

Patients with chronic pain and personality accentuations or disorder only showed a slightly different outcome after interdisciplinary treatment programme and should therefore not be excluded from these programmes. Registered at German Clinical Trials Register (DRKS-ID: DRKS00015141).

Keywords

Chronic pain interdisciplinary treatment programme psychological disorders psychological attenuation outcome after therapy

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References

Fayaz

Croft

Langford

, et al. Prevalence of chronic pain in the UK: a systematic review and meta-analysis of population studies. BMJ Open 2016; 6: e010364.

Mills

SEE

Nicolson

Smith

. Chronic pain: a review of its epidemiology and associated factors in population-based studies. Br J Anaesth 2019; 123: e273–e283.

Pain IAftSo. Classification of chronic pain. Descriptions of chronic pain syndromes and definitions of pain terms. Prepared by the international association for the study of pain, subcommittee on taxonomy. Pain Suppl 1986; 3: S1–226.

GBD. Global, regional, and national incidence, prevalence, and years lived with disability for 328 diseases and injuries for 195 countries, 1990–2016: a systematic analysis for the global burden of disease study 2016. Lancet 2017; 390: 1211–1259.

Edwards

Dworkin

Sullivan

, et al. The role of psychosocial processes in the development and maintenance of chronic pain. J Pain 2016; 17: T70–T92.

Airaksinen

Brox

Cedraschi

, et al. Chapter 4. European guidelines for the management of chronic nonspecific low back pain. Eur Spine J 2006; 15(Suppl 2): S192–S300.

Luchting

Heyn

Hinske

, et al. Expression of miRNA-124a in CD4 cells reflects response to a multidisciplinary treatment program in patients with chronic low back pain. Spine (Phila Pa 1976) 2017; 42: E226–E233.

Kaiser

Sabatowski

Azad

. Multimodal pain therapy. Current situation. Schmerz 2015; 29: 550–556.

Katz

Patterson

Zacharias

. Evaluation of an interdisciplinary chronic pain program and predictors of readiness for change. Can J Pain 2019; 3(1): 70–78.

10.

Guzman

Esmail

Karjalainen

, et al. Multidisciplinary rehabilitation for chronic low back pain: systematic review. Br Med J 2001; 322: 1511–1516.

11.

Kamper

Apeldoorn

Chiarotto

, et al. Multidisciplinary biopsychosocial rehabilitation for chronic low back pain: cochrane systematic review and meta-analysis. Br Med J 2015; 350: h444.

12.

Bohus

Limberger

Ebner

, et al. Pain perception during self-reported distress and calmness in patients with borderline personality disorder and self-mutilating behavior. Psychiatry Res 2000; 95: 251–260.

13.

Giusti

Castelnuovo

Molinari

. Differences in multidisciplinary and interdisciplinary treatment programs for fibromyalgia: a mapping review. Pain Res Manag 2017; 2017: 7261468.

14.

Wallasch

Angeli

Kropp

. Outcomes of a headache-specific cross-sectional multidisciplinary treatment program. Headache 2012; 52: 1094–1105.

15.

de Rooij

van der Leeden

Roorda

, et al. Predictors of outcome of multidisciplinary treatment in chronic widespread pain: an observational study. BMC Musculoskelet Disord 2013; 14: 133.

16.

Grant

Hasin

Stinson

, et al. Prevalence, correlates, and disability of personality disorders in the United States: results from the national epidemiologic survey on alcohol and related conditions. J Clin Psychiatry 2004; 65: 948–958.

17.

Ajo

Inda

Mateu

, et al. Personality and psychiatric disorders in chronic pain male affected by erectile dysfunction: prospective and observational study. Int J Impot Res 2021; 33: 339–347.

18.

Weisberg

. Personality and personality disorders in chronic pain. Curr Rev Pain 2000; 4: 60–70.

19.

Kvarstein

Nordviste

Dragland

, et al. Outpatient psychodynamic group psychotherapy – outcomes related to personality disorder, severity, age and gender. Personal Ment Health 2017; 11: 37–50.

20.

Pfingsten

Arnold

Boger

, et al. Cross-sectoral interdisciplinary multimodal pain therapy: recommendations on structural and process parameters of the ad hoc commission ‘interdisciplinary multimodal pain therapy’ of the German Pain Society (Deutsche Schmerzgesellschaft e. V.). Schmerz 2019; 33: 191–203.

21.

Nagel

Gerbershagen

Lindena

, et al. Development and evaluation of the multidimensional German pain questionnaire. Schmerz 2002; 16: 263–270.

22.

Heyn

Pilgramm

Luchting

. Wohnsituation und chronische Schmerzen. Wohnmedizin 2022; 60: 4–11.

23.

Jahn

Baumgartner

van den Nest

, et al. Criterion validity of the German version of the CES-D in the general population. Psychiatr Prax 2018; 45: 434–442.

24.

Dale

Stacey

. Multimodal treatment of chronic pain. Med Clin North Am 2016; 100: 55–64.

25.

R Core

Team

. R: a language and environment for statistical computing. [Computer Program]. Vienna, Austria: R Foundation for Statistical Computing; 2019.

26.

Bosy

Etlin

Corey

, et al. An interdisciplinary pain rehabilitation programme: description and evaluation of outcomes. Physiother Can 2010; 62: 316–326.

27.

Bourgault

Lacasse

Marchand

, et al. Multicomponent interdisciplinary group intervention for self-management of fibromyalgia: a mixed-methods randomized controlled trial. PLoS One 2015; 10: e0126324.

28.

McWilliams

Higgins

. Associations between pain conditions and borderline personality disorder symptoms: findings from the national comorbidity survey replication. Clin J Pain 2013; 29: 527–532.

29.

Kealy

Tsai

Ogrodniczuk

. Pathological narcissism and somatic symptoms among men and women attending an outpatient mental health clinic. Int J Psychiatry Clin Pract 2016; 20: 175–178.

30.

Apt

Hurlbert

. The sexual attitudes, behavior, and relationships of women with histrionic personality disorder. J Sex Marital Ther 1994; 20: 125–133.

31.

Casser

Arnold

Brinkschmidt

, et al. Multidisciplinary assessment for multimodal pain therapy. Indications and range of performance. Schmerz 2013; 27: 363–370.

32.

Noel

Groenewald

Beals-Erickson

, et al. Chronic pain in adolescence and internalizing mental health disorders: a nationally representative study. Pain 2016; 157: 1333–1338.