Adults in Low and Medium Intensity Group Pain Management Programs Achieve Similar Clinically Significant Outcomes: A Quasi-Experimental Study

Background: Clinical guidelines for adult Pain Management Programs (PMPs) suggest matching program intensity to patient levels of disability and distress. This tertiary adult pain clinic investigated the possibility that a new low-intensity 17-hour group PMP (17-PMP) could provide better value healthcare than an existing medium-intensity 50-hour group PMP (50-PMP). Methods: A quasi-experimental two-group within-between design compared clinical effectiveness of the two programs on standardised outcome measures for adults with persistent pain sequentially allocated to 50-PMP (N=53) then 17-PMP (N=50). Results: Both programs reported clinically significant improvements by the end of the 5-week program or at 3-month followup in measures of pain interference, catastrophizing, self-efficacy, anxiety, stress and the 30-second Chair Stand Test. Pain severity and depression improved in 50-PMP only, though Bayesian testing found evidence of no differences. The Timed Upand-Go improved in 17-PMP only. Neither program reduced opioid use. Both programs achieved completion rates of over 80%. Completers in both programs rated the active self-management strategies they had learned to be of high importance, with moderate to high confidence in using them. Conclusions: The low intensity program achieved similar outcomes on most pain measures compared to the higher intensity program. Uptake of the 17-PMP was rapid, among patients with all levels of disability and distress. It improved access to effective interdisciplinary treatment for adults with persistent pain, using less resources, thus demonstrating better value healthcare.