1. 2015;18;287-297Treatment Outcomes after Combination Interventional and Cognitive Motivational Counseling on Analgesic Medication Use in Patients with Chronic Spine Pain
   Retrospective Case Series
   Ryan Topham, MD, John Jerome, PhD, Anna Dematatis, PhD, and Josh Corteville, BS.

BACKGROUND: Pain interventionists can interrupt pain through anesthetic blockade of neural transmission to virtually any part of the body. Temporary pain relief can be achieved by the direct application of targeted anesthetic. Diagnostically, nerve blocks help identify specific pain generators, refine differential diagnosis, and disrupt the neural transmission mechanisms to stop pain generation peripherally. OBJECTIVE: This study of patients with chronic spine pain was conducted to test the hypothesis that decreasing pain through interventional techniques coupled with cognitive motivational counseling can be highly effective in reducing chronic pain interference, reliance on prescription opioids, and enhancing overall function and quality of life. STUDY DESIGN: Retrospective case series. SETTING: Rehabilitation center. METHODS: Patients: This study involved a retrospective cohort of 78 consecutive patients with spine pain that underwent interventional procedures and cognitive motivational counseling, as well as a comparison group of 77 consecutive patients that underwent interventional procedures only. OUTCOME MEASURES: Pain intensity (DoD VAS), Functional capacity (DoD SS), Global Appraisal (PGIC), Pain site measurement (Drawing), and prescription medication use questionnaires were administered at initial evaluation and after treatment. Pre- and post-treatment changes were compared using paired t-tests. Chi-squared analysis was performed pre- and post-treatment for medication use. RESULTS: The pre- and post-treatment scores for pain intensity, function, and global appraisal demonstrated significant response to treatment (P < 0.001) for the combined interventional and cognitive motivational group (P < 0.001) and the interventional only group (P < 0.05). Compared to initial intake, opioid (P < 0.01), benzodiazepine (P < 0.01), muscle relaxant (P < 0.05), and antidepressant/antianxiolytic (P < 0.05) use only decreased for the combined interventional and cognitive motivational group. LIMITATIONS: This is a retrospective study using medical records and patient self-reported symptoms with possible missed coding and no true random selection, assignment, or genuine control group comparison. CONCLUSION: This study’s results support the hypothesis that a combined interventional and cognitive motivational counseling treatment program can be effective in decreasing spine pain, reducing prescription pain medication use, and improving overall quality of life in chronic spine pain patients.