Neglected topics in the treatment of chronic pain patients — relapse, noncompliance, and adherence enhancement

Turk, Dennis C.; Rudy, Thomas E.

doi:10.1016/0304-3959(91)90142-k

Cited by 311Medication Adherence and ComplianceMusculoskeletal pain and rehabilitationOpioid Use Disorder Treatment

Neglected topics in the treatment of chronic pain patients — relapse, noncompliance, and adherence enhancement

Turk, Dennis C., Rudy, Thomas E.·1991·Pain

DOI 10.1016/0304-3959(91)90142-k

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Abstract

Although published treatment outcome studies for chronic pain have provided favorable support for the efficacy of many pain clinics and the use of specific modalities such as biofeedback and relaxation, there are several factors that mitigate against euphoria. Two related factors that influence interpretation of these reported outcomes are discussed, namely, noncompliance with therapeutic recommendations during treatment and subsequent to treatment termination, and relapse. Conceptual and methodological problems for establishing the prevalence of noncompliance and relapse are reviewed. Several factors that contribute to noncompliance (individual differences, nature of disease or injury, characteristics of the prescribed treatment regimen, health-care provider-patient relationship, and contextual) are discussed. The literature reveals that noncompliance with treatment regimens is quite prevalent across diverse treatment modalities and pain syndromes. The incidence of relapse following initially successful treatment of persistent pain also appears to be high, ranging from 30% to 60%. Studies on arthritis and heterogeneous pain clinic populations suggest that noncompliance and relapse are related; however, this association is less well established for headache patients. Strategies for assessing compliance (i.e., self-report, behavioral, biochemical, and clinical outcome) and the perspectives' of patients and health-care providers on the application of self-care recommendations are discussed. Strategic planning and adherence enhancement tactics to facilitate maintenance of post-treatment gains are described.

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For 30-60% of patients participating in pain management programs, treatment gain is not maintained long-term (1- to 5-year follow-ups).
“It has been indicated that for 30-60% of patients participating in pain management programs, the treatment gain is not maintained long-term (at 1- to 5-year follow-ups) [8,10].”
From A Smartphone-Based Intervention With Diaries and Therapist Feedback to Reduce Catastrophizing and Increase Functioning in Women With Chronic Widespread Pain. Part 2: 11-month Follow-up Results of a Randomized Trial (2013) · cites this paper as [10]
Short-term effects of multidimensional rehabilitation are well established, but concerns about long-term effects have been raised.
“The short-term effects are well established, but concerns about the long-term effects have been raised [7-11].”
From A Smartphone-Based Intervention With Diaries and Therapist Feedback to Reduce Catastrophizing and Increase Functioning in Women With Chronic Widespread Pain. Part 2: 11-month Follow-up Results of a Randomized Trial (2013) · cites this paper as [10]
Few studies have examined home-delivered interventions that aim to support self-management of chronic pain following rehabilitation.
“Few studies have examined home-delivered interventions that aim to support self-management of chronic pain following rehabilitation [11-13].”
From A Smartphone-Based Intervention With Diaries and Therapist-Feedback to Reduce Catastrophizing and Increase Functioning in Women With Chronic Widespread Pain: Randomized Controlled Trial (2013) · cites this paper as [11]
Relapse of symptoms is not uncommon because self-management can be challenging due to the nature of the symptoms.
“However, relapse of symptoms is not uncommon [8,11,12] because self-management can be challenging due to the nature of the symptoms.”
From A Smartphone-Based Intervention With Diaries and Therapist-Feedback to Reduce Catastrophizing and Increase Functioning in Women With Chronic Widespread Pain: Randomized Controlled Trial (2013) · cites this paper as [11]
The results of the long-term effects of multidimensional pain programs are inconclusive and the need for maintenance support has been clearly stated.
“Nevertheless, the results of the long-term effects of multidimensional pain programs are inconclusive and the need for maintenance support has been clearly stated [65,8,11,12].”
From A Smartphone-Based Intervention With Diaries and Therapist-Feedback to Reduce Catastrophizing and Increase Functioning in Women With Chronic Widespread Pain: Randomized Controlled Trial (2013) · cites this paper as [11]

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Core outcome domains for chronic pain clinical trials: IMMPACT recommendations
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Authors: Turk, D. C., & Rudy, T. E.
Affiliations: University of Pittsburgh (US)
Corresponding author: Turk, Dennis C.
Venue: Pain
Publisher: Ovid Technologies (Wolters Kluwer Health)
Published: 1991-01
Volume: 44
Issue: 1
Pages: 5-28
ISSN: 0304-3959 (ISSN-L)
DOI: 10.1016/0304-3959(91)90142-k
OpenAlex: W2033451235
Cited by: 311
References: 154
Citations by year: 2026: 1 · 2025: 3 · 2024: 4 · 2023: 6 · 2022: 4 · 2021: 8 · 2020: 13 · 2019: 8 · 2018: 9 · 2017: 8 · 2016: 4 · 2015: 4 · 2014: 4 · 2013: 8 · 2012: 15
FWCI: 1.66
Type: journal article
Language: en
Open access: closed
Locations: Pain (publishedVersion)
PubMed (publishedVersion)
Funders: National Institutes of Health (5r01ar038698-07, 5r01de007514-14)
National Institute of Arthritis and Musculoskeletal and Skin Diseases (2R01AR38698)
National Institute of Dental and Craniofacial Research (2R01DE07514)
Topics: Health Sciences › Medicine › Family Practice › Medication Adherence and Compliance
Health Sciences › Medicine › Pharmacology › Musculoskeletal pain and rehabilitation
Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Opioid Use Disorder Treatment
Keywords: chronic pain, relapse, treatment non-adherence, medication adherence, pain clinic, biofeedback, relaxation training, healthcare provider-patient relationship, self-care, headache, arthritis
MeSH terms: Chronic Disease, Humans, Pain, Patient Compliance, Recurrence, Pain Management

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Neglected topics in the treatment of chronic pain patients — relapse, noncompliance, and adherence enhancement

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