Evaluation of a Four Week Interdisciplinary Multimodal Pain Therapy on Chronic Pain Patients—A Comprehensive Approach
Abstract
1. Introduction
2. Materials and Methods
2.1. Study Cohort
2.2. Inclusion and Exclusion Criteria
2.3. Ethics and Data Privacy
2.4. Statistical Analysis
2.5. HUBER® 360
2.6. Outcome Measures
2.7. Questionnaires
- German Pain Questionnaire (DSF) and Depression, Anxiety, and Stress Scale (DASS): The DSF is widely used in pain therapy settings to collect baseline data and develop tailored therapy concepts. It includes demographic data (age, gender, weight, height), subjective pain descriptions (occurrence, frequency, intensity, location), questions about daily life, medical history, psychological factors (depression, stress, anxiety, quality of life), and social data (education, insurance, employment, family, retirement) [29,30]. In this study, DSF version 2015.2, which includes the DASS, was used. Comorbidities were recorded and the Charlson Comorbidity Index calculated [31]. To assess the development of pain intensity and the success of therapy for patients in the outpatient pain clinic and beyond, various follow-up questionnaires of the DSF were used [32], such as the progress questionnaire, which was sent to the patients 3 months after intervention.
- Numerical Rating Scale (NRS): The NRS asks patients to rate their pain on an 11-point scale from 0 (no pain) to 10 (maximum pain) [33]. During the therapy, pain intensity was recorded every morning using the NRS for a total of 20 days, to tailor the therapy and evaluate its success.
- Mainz Pain Staging System (MPSS) by Gerbershagen: The MPSS is a coding system used to stage chronic pain based on temporal and spatial aspects, medication behavior, and patient history [34,35]. This classification facilitates the comparison of chronic pain patients and the provision of appropriate therapy. The MPSS is widely used in Germany, as it allows quick and simple evaluation from patients’ data, showing a strong correlation between pain chronification, psychological condition, and daily life impairment. High chronic pain stages often correlate with significant work disability [36].
- Graded Chronic Pain Status (GCPS) by von Korff: The GCPS is an internationally accepted method for assessing chronic pain based on pain intensity and disability. The classification by von Korff uses pain intensity, disability, persistence, and frequency to categorize chronic pain in a straightforward manner [37].
- European Quality of Life 5 Dimensions 3 Level Version (EQ-5D-3L): Developed by the EuroQol Group, this questionnaire assesses health-related quality of life across five dimensions: mobility, self-care, usual activities, pain/discomfort, and anxiety/depression [38]. An extra question about current health status was added for this study. A visual analog scale (EQ-VAS) is included, where patients rate their health on a scale from 0 (worst imaginable health) to 100 (best imaginable health).
- Short-Form 36 Health Survey (SF-36): The SF-36 is widely used to measure health-related quality of life (HRQOL) across eight subcategories, with an additional question on health changes over the past year. Subcategories include physical functioning, physical role, emotional role, social functioning, bodily pain, vitality, mental health, and general health perception. It includes two summary scores: physical health component (PCS) and mental health component (MCS) [39,40,41]. Higher scores indicate less impairment and better quality of life. Chronic pain significantly impacts these scores, particularly with increased pain severity, leading to lower HRQOL [41,42].
3. Results
3.1. Descriptive Data
3.2. Pain
3.3. Patient Satisfaction and Quality of Life
EQ-5D-3L
3.4. Psychological Parameters
3.4.1. Short Form-36
3.4.2. Depression Anxiety Stress Score (DASS)
4. Discussion
Limitations and Strengths
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
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Intervention Group (n = 49) | Control Group (n = 17) | Group Comparison t1 | |||
---|---|---|---|---|---|
Mean (±SD) | Median (Range) | Mean (±SD) | Median (Range) | p-Value | |
Age | 54.7 (±12.4) | 56 (27; 79) | 61.8 (±14.5) | 60 (38; 82) | 0.058 1 |
BMI | 26.7 (±5.95) | 24.49 (17.9; 40) | 29.07 (±5.6) | 29.2 (18.3; 37.2) | 0.107 2 |
CCI | 1.57 (±1.58) | 1 (0; 6) | 2.47 (±2.15) | 2 (0; 6) | 0.178 2 |
NRS day 1 | 5.71 (±1.94) | 6 (1; 9) | 5.76 (±1.79) | 6 (3; 9) | 0.964 2 |
Intervention Group (n = 49) | Control Group (n = 17) | ||
---|---|---|---|
Absolute (Percentage %) | Absolute (Percentage %) | ||
Sex | female | 40 (81.6%) | 12 (70.6) |
male | 9 (18.4) | 5 (29.4) | |
Charlson Comorbidity Index | 0 | 14 (28.6%) | 4 (23.5%) |
1 | 15 (30.6%) | 4 (23.5%) | |
2 | 9 (18.4%) | 1 (5.9%) | |
3 | 6 (12.2%) | 2 (11.8%) | |
4 | 0 (0%) | 1 (5.9%) | |
5 | 4 (8.2%) | 4 (23.5%) | |
6 | 1 (2%) | 1 (5.9%) | |
Disability | Yes | 27 (55.1%) | 10 (58.8%) |
No | 22 (44.9%) | 7 (41.2%) | |
Cause of pain (multiple answer options) | no recognizable cause | 6 (12.2%) | 1 (5.9%) |
specific disease | 23 (46.9%) | 6 (35.3%) | |
operation | 16 (32.7%) | 9 (52.9%) | |
accident | 5 (10.2%) | 3 (17.6%) | |
physical strain * | 22 (44.9%) | 2 (11.8%) | |
mental stress | 17 (34.7%) | 3 (17.6%) | |
other cause | 5 (10.2%) | 0 (0%) | |
Duration of pain | 1 month to ½ year | 2 (4.1%) | 1 (5.9%) |
½ year to 1 year | 4 (8.2%) | 2 (11.8%) | |
1 to 2 years | 5 (10.2%) | 1 (5.9%) | |
2 to 5 years | 11 (22.4%) | 5 (29.4%) | |
more than 5 years | 27 (55.1%) | 8 (47.1%) | |
Mainz Pain Staging System (MPSS) | stage 1 | 0 (0%) | 0 (0%) |
stage 2 | 3 (6.1%) | 1 (5.9%) | |
stage 3 | 46 (93.9%) | 16 (94.1%) | |
Graded Chronic Pain Status (GCPS) by von Korff | grade 1 | 1 (2%) | 1 (5,9%) |
grade 2 | 8 (16.3%) | 1 (5.9%) | |
grade 3 | 9 (18.4%) | 2 (11.8%) | |
grade 4 | 31 (63.3%) | 13 (76.5%) |
Intervention Group | Control Group | 2-Way ANOVA p-Value (Time X HUBER® 360) | |||||||
---|---|---|---|---|---|---|---|---|---|
t1 | t3 | t4 | t1 | t3 | t4 | p-Value | |||
EQ-5D-3L Index Value | mean (±SD) | 0.55 (±0.30) | 0.78 (±0.18) | 0.68 (±0.28) | 0.64 (±0.26) | 0.73 (±0.22) | 0.65 (±0.29) | <0.001 1 | 0.263 |
median (range) | 0.564 (0.11; 1) | 0.877 (0.175; 1) | 0.788 (0.11; 1) | 0.701 (0.175; 0.887) | 0.788 (0.175; 0.887) | 0.788 (0.175; 0.887) | 0.036 2 | ||
EQ-5D-3L Visual Analog Scale | mean (±SD) | 49.82 (±17.38) | 62.14 (±15.1) | 55,5 (±19.13) | 47.53 (±12.5) | 55.12 (±17.76) | 54.57 (±18.22) | 0.003 1 | 0.696 |
median (range) | 50 (10; 100) | 60 (30; 100) | 55 (4; 95) | 48 (25; 70) | 60 (15; 85) | 55 (9; 75) | 0.014 2 |
Intervention Group | Control Group | Two-Way ANOVA p-Value (Time X HUBER® 360) | |||||
---|---|---|---|---|---|---|---|
t1 | t3 | t1 | t3 | p-Value | |||
Physical component summary | mean (±SD) | 34.54 (±19.1) | 48.65 (±21.28) | 28.62 (±11.66) | 40.75 (±17.51) | 0.235 1 0.174 2 <0.001 3 0.003 4 | 0.668 |
median (range) | 31.25 (6.25; 85.5) | 44.75 (7.5; 89) | 28 (15.5; 63) | 37 (9.25; 84.75) | |||
Mental component summary | mean (±SD) | 48.32 (±22.72) | 58.09 (±23.57) | 53.37 (±19.86) | 69.96 (±16.49) | 0.419 1 0.060 2 <0.001 3 <0.001 4 | 0.191 |
median (range) | 3.25 (3.75; 91.5) | 61.55 (3.75; 94.25) | 45.17 (21.75; 89.75) | 71.38 (40; 97.75) | |||
SF-36 overall | mean (±SD) | 41.43 (±18.58) | 53.37 (±20.62) | 40.99 (±13.54) | 55.36 (±15.43) | 0.929 1 0.718 2 <0.001 3 <0.001 4 | 0.567 |
median (range) | 38.23 (7.75; 88.5) | 53.88 (5.63; 88.25) | 37.88 (19.25; 76.38) | 51.38 (27.13; 91.25) |
Intervention Group | Control Group | Two-Way ANOVA p-Value (Time X HUBER® 360) | |||||
---|---|---|---|---|---|---|---|
t1 | t3 | t1 | t3 | p-Value | |||
Depression | mean (±SD) | 9.65 (±5.11) | 3.63 (±4.02) | 7 (±3.59) | 2.12 (±2.52) | 0.053 1 0.151 2 <0.001 3 <0.001 4 | 0.402 |
median (range) | 9 (0; 21) | 2 (0; 20) | 8 (2; 12) | 2 (0; 10) | |||
Anxiety | mean ± (SD) | 5.69 (±3.96) | 3.14 (±3.27) | 3 (±2.94) | 2.71 (±3.31) | 0.013 1 0.637 2 <0.001 3 0.703 4 | 0.014 |
median (range) | 4 (0; 16) | 2 (0; 15) | 3 (0; 11) | 2 (0; 12) | |||
Stress | mean (±SD) | 10.8 (±4.86) | 5.88 (±4.15) | 8.35 (±3.71) | 3.71 (±2.31) | 0.064 1 0.045 2 <0.001 3 <0.001 4 | 0.836 |
median (range) | 10 (2; 21) | 5 (0; 16) | 8 (2; 16) | 3 (1; 10) |
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Paulokat, H.M.; Klinder, A.; Mittelmeier, W.; Bajorat, J.; Osmanski-Zenk, K. Evaluation of a Four Week Interdisciplinary Multimodal Pain Therapy on Chronic Pain Patients—A Comprehensive Approach. Life 2025, 15, 576. https://doi.org/10.3390/life15040576
Paulokat HM, Klinder A, Mittelmeier W, Bajorat J, Osmanski-Zenk K. Evaluation of a Four Week Interdisciplinary Multimodal Pain Therapy on Chronic Pain Patients—A Comprehensive Approach. Life. 2025; 15(4):576. https://doi.org/10.3390/life15040576
Chicago/Turabian StylePaulokat, Henrike Maria, Annett Klinder, Wolfram Mittelmeier, Jörn Bajorat, and Katrin Osmanski-Zenk. 2025. "Evaluation of a Four Week Interdisciplinary Multimodal Pain Therapy on Chronic Pain Patients—A Comprehensive Approach" Life 15, no. 4: 576. https://doi.org/10.3390/life15040576
APA StylePaulokat, H. M., Klinder, A., Mittelmeier, W., Bajorat, J., & Osmanski-Zenk, K. (2025). Evaluation of a Four Week Interdisciplinary Multimodal Pain Therapy on Chronic Pain Patients—A Comprehensive Approach. Life, 15(4), 576. https://doi.org/10.3390/life15040576