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Chronic pain is associated with a range of other problems, including disturbed sleep, depression, anxiety, fatigue, reduced quality of life, and an inability to work or socialise. We investigated whether good symptom control of pain (using definitions of moderate and substantial benefit) is associated with improvement in other symptoms. Individual patient data from four randomised trials in fibromyalgia (2575 patients) lasting 8-14weeks were used to calculate percentage pain reduction for each completing patient (1858), divided into one of five groups according to pain reduction, irrespective of treatment: substantial benefit - 50% pain reduction; moderate - 30% to <50%; minimal - 15% to <30%; marginal - 0% to <15%; worse - <0% (increased pain intensity). We then calculated change from baseline to end of trial for measures of fatigue, function, sleep, depression, anxiety, ability to work, general health status, and quality-adjusted life year (QALY) gain over a 12-month period. Substantial and moderate pain intensity reductions were associated with statistically significant reduction from baseline by end of trial in all measures, with values by trial end at or approaching normative values. Substantial pain intensity reduction resulted in 0.11 QALYs gained, and moderate pain intensity reduction in 0.07 QALYs gained over a 12-month period. Substantial and moderate pain intensity reduction predicts broad beneficial outcomes and improved quality of life that do not occur without pain relief. Pain intensity reduction is a simple and effective predictor of which patients should continue treatment, and which should discontinue and try an alternative therapy.

Original publication

DOI

10.1016/j.pain.2010.02.039

Type

Journal article

Journal

Pain

Publication Date

05/2010

Volume

149

Pages

360 - 364

Keywords

Activities of Daily Living, Adult, Analgesics, Fatigue Syndrome, Chronic, Female, Fibromyalgia, Health Status, Humans, Male, Mood Disorders, Outcome Assessment (Health Care), Pain Measurement, Pain Threshold, Pregabalin, Quality of Life, Severity of Illness Index, Sick Leave, Stress, Psychological, Treatment Outcome, gamma-Aminobutyric Acid