Drop-out from chronic pain treatment programmes: Is randomization justified in biopsychosocial approaches?, 2021, Bicego et al

[Andy]

Abstract
Objective: To identify profiles of patients who are at risk of dropping out from biopsychosocial approaches to chronic pain management.

Patients: A total of 575 patients were included in the study. Of these, 203 were randomized into 4 treatment groups: self-hypnosis/self-care; music/self-care; self-care; and psychoeducation/cognitive behavioural therapy. The remaining 372 patients were not randomized, as they presented with the demand to learn self-hypnosis/self-care, and therefore were termed a “self-hypnosis/self-care demanders” group.

Methods: Socio-demographics and behavioural data were included in the analyses. Univariates analyses, comparing early drop-outs (never attended treatment), late drop-outs (6/9 sessions’ treatment) and continuers were conducted in order to select variables to include in a multivariate logistic regression.

Results: Univariate analyses yielded 8 variables, out of 18 potential predictors for drop-out, which were eligible for inclusion in the multivariate logistic regression. The model showed that having an intermediate or high educational level protects against dropping out early or late in the pain management process. Having to wait for more than 4 months before starting the treatment increases the risk of never starting it. Being randomized increases the risk of never starting the treatment.

Conclusion: In a context in which randomization is considered a “gold standard” in evidence-based practice, these results indicate that this very principle could be deleterious to pain management in patients with chronic pain.

Lay Abstract
The aim of this study was to identify profiles of patients who are at risk of dropping out from biopsychosocial approaches to chronic pain management. A total of 575 patients were included in the study. Of these, 203 patients were randomized into 4 treatment groups: self-hypnosis-/self-care; music/self-care; self-care; psychoeducation/cognitive behavioural therapy. The remaining 372 patients were not randomized, as they presented with the demand to learn self-hypnosis/self-care, and hence formed a “self-hypnosis/self-care demanders” group. Analyses of socio-demographics and behavioural data were conducted, comparing early drop-outs (never attended treatment), late drop-outs (6/9 sessions’ treatment) and continuers. Results showed that having an intermediate or high educational level protects against dropping out early or late in the management process. Having to wait for more than 4 months before starting the treatment, and being randomized, increases the risk of never starting it. Thus, in a context in which randomization is considered as a “gold standard” in evidence-based practice, these results indicate that this very principle could be deleterious to pain management in patients with chronic pain.

Abstract-only at time of posting, https://www.medicaljournals.se/jrm/content/abstract/10.2340/16501977-2824

 

[Jonathan Edwards]

Thus, in a context in which randomization is considered as a “gold standard” in evidence-based practice, these results indicate that this very principle could be deleterious to pain management in patients with chronic pain.

Do the authors not realise that randomisation only occurs in trials, not in normal service treatment? So how can randomisation be deleterious to normal service treatment?

 

[Trish]

That was my immediate thought too. What a daft idea for a study.

So surprise surprise, patients may stick with a treatment for longer if they get quick access to it and have a free choice from a tasty selection. Whether any of the 'treatments' work is another matter.

 

[rvallee]

They can't even consider the obvious explanation for most drop-outs: it's completely useless. In the many BPS papers I have seen going around, I have never seen a single examination of drop-outs. They are simply stated as a number and no one ever asks or questions why. Not one that I can remember anyway. The possibility that the treatment is useless is simply not considered.

Literally the very foundational principle of the scientific method: you are probably wrong and should assume so. And it's literally excluded from any consideration. Amazing. EBM truly is an anti-science process, an alternative to science in every possible way.

 

[Sean]

So, adequate controls are out, and now randomisation is out.

Not much left of the R & C in RCT (Randomised Controlled Trial).

All that is left is a trial for patients. But we knew that already.

 

[shak8]

Personal experience with a chronic pain treatment program. If you wanted a pain med, you had to show up at the 8 weekly sessions. So generic. I learned that I don't have to make my bed and I should shop for all groceries at one store. That was the useful stuff.

We had therabands (huge stretchy bands) to use. I got the most godawful pain from using them.

By the way, CBT is like post structuralism, a cultish system. Useless. When I'm in a deep pain, sure, I am naturally catastrophizing for as long as the intensity of pain signals warrants. Ho-hum.