Health-related quality of life in patients with chronic pain

Pekka Vartiainen

Research output: ThesisDoctoral ThesisCollection of Articles

Abstract

Chronic pain impairs health and both physical and cognitive function, and is associated with considerable psychosocial problems. The management of chronic pain is challenging, and multidisciplinary pain management (MPM) is considered the most efficacious method of treating chronic pain. However, treatment outcomes vary greatly, and it is not possible to predict which patients will benefit from MPM. Health-related quality of life (HRQoL) measurement aims to capture the comprehensive, subjective health state of a patient. Generic HRQoL enables comparison across all patient populations and is an integral component of cost-utility studies. Although measuring HRQoL is considered essential for treatment effectiveness, the validity of different instruments for pain treatment have not previously been compared. The thesis consists of three publications, and reports on two patient populations. The validity of the two HRQoL instruments, the EQ-5D and the 15D was studied using a sample of 391 patients attending secondary or tertiary multidisciplinary pain clinics. The second study sample consisted of 1528 patients with chronic non-cancer pain, treated at a tertiary multidisciplinary pain clinic of the Helsinki University Hospital. We compared the baseline HRQoL results with those of an age- and gender-matched sample of the general population, and studied the association between HRQoL and background variables using stepwise linear regression. We examined the mean and individual changes in HRQoL and studied the association between the background variables and the HRQoL change using linear and logistic regression methods. The EQ-5D and the 15D showed moderate agreement, but the scores had considerable differences. Both HRQoL instruments were strongly associated with the pain-related factors, but the 15D appeared slightly more sensitive than the EQ-5D in relation to the psychosocial factors of chronic pain, and had better discriminatory power in better health states. The mean HRQoL of chronic pain patients in tertiary care was very low, much below that of the general population sample, and one of the lowest reported by the 15D instrument. The 15D HRQoL score was associated with measures of psychosocial burden of chronic pain, but pain intensity had no independent predictive value in HRQoL. There was a clinically and statistically significant mean improvement (+0.017) in the 15D score 12 months after the beginning of MPM. 53% of patients reported a clinically significant improvement, and 43% a major improvement in their 15D HRQoL score. However, the HRQoL changes varied considerably, and the mean HRQoL of the patients remained below that of the general population and most other patient populations. Being employed, having a higher education, and shorter pain duration as the only pain-related variable were associated with a higher probability of improvement. The results demonstrate the validity of the two HRQoL instruments in patients with chronic pain; the widely-used EQ-5D and the 15D. However, the scores that the two instruments produced differed considerably, the results slightly favouring the 15D. The very low observed HRQoL underlines the considerable burden of disease among patients with chronic pain, and the psychosocial aspects of pain were important in determining the overall quality of life. The large variations in the changes in HRQoL after MPM imply a need to better recognize patients who will or will not benefit from the treatment.
Original languageEnglish
Supervisors/Advisors
  • Kalso, Eija, Supervisor
  • Roine, Risto Paavo Antero, Supervisor
Place of PublicationHelsinki
Publisher
Print ISBNs978-951-51-4445-4
Electronic ISBNs978-951-51-4446-1
Publication statusPublished - 2018
MoE publication typeG5 Doctoral dissertation (article)

Fields of Science

  • Chronic Pain
  • Pain, Intractable
  • Pain Management
  • Quality of Life
  • Cost of Illness
  • Pain Measurement
  • +methods
  • Patient Care Team
  • Socioeconomic Factors
  • Pain Clinics
  • 3126 Surgery, anesthesiology, intensive care, radiology

Cite this

Vartiainen, P. (2018). Health-related quality of life in patients with chronic pain. Helsinki: Helsingin yliopisto.
Vartiainen, Pekka. / Health-related quality of life in patients with chronic pain. Helsinki : Helsingin yliopisto, 2018. 116 p.
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Health-related quality of life in patients with chronic pain. / Vartiainen, Pekka.

Helsinki : Helsingin yliopisto, 2018. 116 p.

Research output: ThesisDoctoral ThesisCollection of Articles

TY - THES

T1 - Health-related quality of life in patients with chronic pain

AU - Vartiainen, Pekka

N1 - M1 - 116 s. + liitteet

PY - 2018

Y1 - 2018

N2 - Chronic pain impairs health and both physical and cognitive function, and is associated with considerable psychosocial problems. The management of chronic pain is challenging, and multidisciplinary pain management (MPM) is considered the most efficacious method of treating chronic pain. However, treatment outcomes vary greatly, and it is not possible to predict which patients will benefit from MPM. Health-related quality of life (HRQoL) measurement aims to capture the comprehensive, subjective health state of a patient. Generic HRQoL enables comparison across all patient populations and is an integral component of cost-utility studies. Although measuring HRQoL is considered essential for treatment effectiveness, the validity of different instruments for pain treatment have not previously been compared. The thesis consists of three publications, and reports on two patient populations. The validity of the two HRQoL instruments, the EQ-5D and the 15D was studied using a sample of 391 patients attending secondary or tertiary multidisciplinary pain clinics. The second study sample consisted of 1528 patients with chronic non-cancer pain, treated at a tertiary multidisciplinary pain clinic of the Helsinki University Hospital. We compared the baseline HRQoL results with those of an age- and gender-matched sample of the general population, and studied the association between HRQoL and background variables using stepwise linear regression. We examined the mean and individual changes in HRQoL and studied the association between the background variables and the HRQoL change using linear and logistic regression methods. The EQ-5D and the 15D showed moderate agreement, but the scores had considerable differences. Both HRQoL instruments were strongly associated with the pain-related factors, but the 15D appeared slightly more sensitive than the EQ-5D in relation to the psychosocial factors of chronic pain, and had better discriminatory power in better health states. The mean HRQoL of chronic pain patients in tertiary care was very low, much below that of the general population sample, and one of the lowest reported by the 15D instrument. The 15D HRQoL score was associated with measures of psychosocial burden of chronic pain, but pain intensity had no independent predictive value in HRQoL. There was a clinically and statistically significant mean improvement (+0.017) in the 15D score 12 months after the beginning of MPM. 53% of patients reported a clinically significant improvement, and 43% a major improvement in their 15D HRQoL score. However, the HRQoL changes varied considerably, and the mean HRQoL of the patients remained below that of the general population and most other patient populations. Being employed, having a higher education, and shorter pain duration as the only pain-related variable were associated with a higher probability of improvement. The results demonstrate the validity of the two HRQoL instruments in patients with chronic pain; the widely-used EQ-5D and the 15D. However, the scores that the two instruments produced differed considerably, the results slightly favouring the 15D. The very low observed HRQoL underlines the considerable burden of disease among patients with chronic pain, and the psychosocial aspects of pain were important in determining the overall quality of life. The large variations in the changes in HRQoL after MPM imply a need to better recognize patients who will or will not benefit from the treatment.

AB - Chronic pain impairs health and both physical and cognitive function, and is associated with considerable psychosocial problems. The management of chronic pain is challenging, and multidisciplinary pain management (MPM) is considered the most efficacious method of treating chronic pain. However, treatment outcomes vary greatly, and it is not possible to predict which patients will benefit from MPM. Health-related quality of life (HRQoL) measurement aims to capture the comprehensive, subjective health state of a patient. Generic HRQoL enables comparison across all patient populations and is an integral component of cost-utility studies. Although measuring HRQoL is considered essential for treatment effectiveness, the validity of different instruments for pain treatment have not previously been compared. The thesis consists of three publications, and reports on two patient populations. The validity of the two HRQoL instruments, the EQ-5D and the 15D was studied using a sample of 391 patients attending secondary or tertiary multidisciplinary pain clinics. The second study sample consisted of 1528 patients with chronic non-cancer pain, treated at a tertiary multidisciplinary pain clinic of the Helsinki University Hospital. We compared the baseline HRQoL results with those of an age- and gender-matched sample of the general population, and studied the association between HRQoL and background variables using stepwise linear regression. We examined the mean and individual changes in HRQoL and studied the association between the background variables and the HRQoL change using linear and logistic regression methods. The EQ-5D and the 15D showed moderate agreement, but the scores had considerable differences. Both HRQoL instruments were strongly associated with the pain-related factors, but the 15D appeared slightly more sensitive than the EQ-5D in relation to the psychosocial factors of chronic pain, and had better discriminatory power in better health states. The mean HRQoL of chronic pain patients in tertiary care was very low, much below that of the general population sample, and one of the lowest reported by the 15D instrument. The 15D HRQoL score was associated with measures of psychosocial burden of chronic pain, but pain intensity had no independent predictive value in HRQoL. There was a clinically and statistically significant mean improvement (+0.017) in the 15D score 12 months after the beginning of MPM. 53% of patients reported a clinically significant improvement, and 43% a major improvement in their 15D HRQoL score. However, the HRQoL changes varied considerably, and the mean HRQoL of the patients remained below that of the general population and most other patient populations. Being employed, having a higher education, and shorter pain duration as the only pain-related variable were associated with a higher probability of improvement. The results demonstrate the validity of the two HRQoL instruments in patients with chronic pain; the widely-used EQ-5D and the 15D. However, the scores that the two instruments produced differed considerably, the results slightly favouring the 15D. The very low observed HRQoL underlines the considerable burden of disease among patients with chronic pain, and the psychosocial aspects of pain were important in determining the overall quality of life. The large variations in the changes in HRQoL after MPM imply a need to better recognize patients who will or will not benefit from the treatment.

KW - Chronic Pain

KW - Pain, Intractable

KW - Pain Management

KW - Quality of Life

KW - Cost of Illness

KW - Pain Measurement

KW - +methods

KW - Patient Care Team

KW - Socioeconomic Factors

KW - Pain Clinics

KW - 3126 Surgery, anesthesiology, intensive care, radiology

M3 - Doctoral Thesis

SN - 978-951-51-4445-4

T3 - Dissertationes scholae doctoralis ad sanitatem investigandam Universitatis Helsinkiensis

PB - Helsingin yliopisto

CY - Helsinki

ER -

Vartiainen P. Health-related quality of life in patients with chronic pain. Helsinki: Helsingin yliopisto, 2018. 116 p. (Dissertationes scholae doctoralis ad sanitatem investigandam Universitatis Helsinkiensis; 63/2018).