Psychosocial factors that are predictive of changes in pain severity in the multidisciplinary treatment of chronic pain: A cohort study

The Pain Management Center at our hospital provides a multidisciplinary outpatient program for chronic pain. Although improving quality of life is the primary goal, pain reduction is also desirable; however, psychosocial predictors of pain change remain unclear. This cohort study examined whether baseline psychosocial factors predict clinically meaningful pain improvement at 6 months. We analyzed 98 patients with chronic pain who completed questionnaires at baseline and 6 months between April 2015 and March 2023. Pain severity was measured using the Brief Pain Inventory (average pain), and improvement was defined as a ≥2–point reduction from baseline to 6 months. Baseline psychosocial factors and quality of life were assessed using validated scales (Pain Catastrophizing Scale, Pain Disability Assessment Scale, Hospital Anxiety and Depression Scale, Pain Self–Efficacy Questionnaire, Athens Insomnia Scale, 25–question Geriatric Locomotive Function Scale, Brief Scale for Psychiatric Problems in Orthopaedics Patients, and EuroQol–5D). Patients were classified as improved or non–improved, and multivariable logistic regression was performed after evaluating collinearity among candidate predictors. Age, sex, and ICD–11 classification did not differ between groups. In the multivariable model, the rumination subscale of the Pain Catastrophizing Scale was independently associated with pain improvement (odds ratio 0.869, 95% CI 0.757–0.998), indicating lower baseline rumination was associated with higher odds of pain improvement. Rumination may therefore be an important target for assessment and intervention at the initial visit.