Patients referred from a multidisciplinary pain clinic to the social worker, their general health, pain condition, treatment and outcome

Abstract

Abstract Background and aims As far as we know, the range of issues particular to social work, when working with clients at a pain clinic has not been previously researched. Methods A retrospective study of referrals at the multidisciplinary Pain Clinic of Helsinki University Central Hospital was conducted based on medical records, focusing on pain conditions, treatments and patient flow. Variables used were age, gender, pain conditions, treatment interventions, pain duration and intensity, disruption in everyday life due to pain, psychiatric co-morbidities, referrals, outside care providers, post-treatment care and health habits. Referrals were made mainly by other HUCH units or municipal health centers. Results The median age of patients (n = 55) was 44 years. The majority of patients were referred to the pain clinic by municipal health centers. Almost similar number of patients was referred by other HUCH clinics. The largest disease group was musculoskeletal diseases, afflicting 25 patients. Almost the same number of patients (22) suffered from neurological and sensory nervous system diseases. Three patients suffered from persistent somatoform pain disorder and five patients did not fall into any of these categories. Pharmacotherapy was the most prevalent treatment method at the pain clinic, and it was prescribed to all patients. The post-treatment care of the patients was mainly provided by primary health care services. Duration of pain was more than 3 years in more than 60% of the patients. There was a considerable lack of information about pain intensity in the patient files. For the majority of patients, pain caused difficulty in movement, housework, recreation, and sleeping. Patients referred to the pain clinic's social worker had not benefited greatly from previous interventions. More than half of the patients had received psychiatric consultation either at the pain clinic or in some other setting. Most often the patients had been diagnosed to suffer from depression by a psychiatrist. Over a third of the patients had reported suicidal intents to the hospital staff. Conclusions The pain situation of patients was severe, in terms of intensity and disability. Treatment was primarily based on drug therapy, and patients generally continued treatment in outpatient services. Depression and substance abuse were common; a third had experienced suicidal intent. By searching for symptoms, the social worker pays attention to signs of depression at the clinic. Co-operation with social workers in outpatient services is also critical for social after-care. This requires that the social worker of a pain center has an excellent and practical knowledge of the social welfare and service systems.