NEGLECTED TOPICS IN CHRONIC PAIN TREATMENT OUTCOME STUDIES - DETERMINATION OF SUCCESS

Although literature on chronic pain treatment outcome has made substan tial strides in improving the quality of the studies reported, there r emain a number of factors that lead to qualification of the generally positive results. In the two previous papers in this series a set of m itigating factors was discussed, namely, representativeness of the sam ples treated in these outcome studies, relapse, and non-compliance wit h therapeutic recommendations. Additional limitations include the lack of agreement on the criteria on which to base evaluation of the succe ss of treatment outcome and the percentage of treated patients include d in follow-up data. In this paper, the most common methods for determ ining success are described (group effects based on standard and quasi -standard outcome measures). The limitations of this approach are disc ussed and alternative strategies are presented that focus not only on traditional criteria based on group means but on additional criteria i ncluding: (a) importance of change (i.e., clinical vs. statistical sig nificance), (b) proportion of patients who improve, (c) cost, (d) effi ciency in treatment delivery, (e) and consumer acceptance and satisfac tion.