Wellness of patients with chronic pain is not only about pain intensity

Objective: Attaining good outcomes in the management of chronic pain remains a clinical challenge. This study aimed to investigate the relationships between - and the contribution of - pain and related conditions to the wellness of these patients.

Design: A secondary analysis of database of patients with chronic pain treated with medical cannabis (MC) to carry out a one-year prospective follow-up study was conducted. Questionnaires were completed before (T₀ ), six (T₆ ), and twelve (T₁₂ ) months after MC initiation. Data included patients' demographics and questionnaires related to three latent factors: pain intensity measures, related conditions (catastrophizing, sleep disturbance, anxiety, and depression), and wellness parameters (quality-of-life, disability, subjective-health-state). Weighted average of the observed variables (WOBs) were calculated for each latent factor. Longitudinal structural equation modeling (SEM) and mediation analyses were performed to identify predictors and interrelations between the WOBs, respectively.

Results: Participants included 510 patients. All variables were significantly improved from T₀ to T₆ and T₁₂ . SEM revealed that related conditions, and to a lesser extent pain, predicted wellness at T₀ , T₆ , and T₁₂ (related conditions: β₀ = 0.55, p < 0.001; β₆ = 0.54, p < 0.001; and β₁₂ = 0.51, p < 0.001; pain: β₀ = 0.42, p < 0.001; β₆ = 0.18, p < 0.001; and β₁₂ = 0.25, p < 0.001). Mediation analyses demonstrated that the effect of WOB-related conditions was greater than WOB-pain on wellness.

Conclusion: Wellness of patients with chronic pain can be determined not only by pain itself but even more so by the severity of related conditions. Thus, considering a broad spectrum of pain measures and related conditions seems relevant for improving the wellness of patients with chronic pain.