Exploration of the impact of Obsessive-Compulsive Disorder in Chronic Pain and associated rehabilitation through a mixed-method design.

The aim of this study is to explore the prevalence and impact of Obsessive-Compulsive Disorder (OCD) amongst Chronic Pain sufferers attending a Community Pain Service in New Zealand. Community Pain Services in New Zealand are specialist multidisciplinary services consisting of two stages, with individuals with Chronic Pain issues referred into the first stage. The second stage expands and builds upon services delivered in the first stage, and includes mandatory medical practitioner input and medication review. Progression into a second stage depends on individual needs, complexity of barriers to pain rehabilitation, and resource requirements. There are no specific timeframes for completion of a Community Pain Service Programme, although there are limitations in terms of resources and funding. As part of standard service practices, Electronic Persistent Pain Outcome Collaboration (ePPOC) data sets are administered at intake and on completion (either at stage one or two depending on the individual’s service progression) points of individual Pain Service programmes. These data sets contain 17 registration and demographic items; a total of 56 questions across five individual clinical assessment measures (i.e. Brief Pain Inventory [BPI], Body Map, Depression Anxiety Stress Scale-21 [DASS-21], Pain Self-Efficacy Questionnaire [PSEQ], and Pain Catastrophising Scale [PCS]); as well as supplementary questions relating to medication, health services utilization, and treatment provided. The estimated completion time for these data sets are 20 minutes, although this is subject to personal variability for factors such age, language, and level of disability. A study flyer, including the primary researcher’s (CS) contact details, will be included with initial service documents sent to individuals starting at a Community Pain Service with a private rehabilitation-focused company, Habit Health. Pain Service Key Workers (clinicians performing the initial assessment and managing the overall programme) will also approach already enrolled, and eligible, service clients at any time during the course of their active programme (no set time frame), to inform them of the study and to attain verbal consent for their contact details to be passed on to the primary researcher. The primary researcher would then contact, or be contacted by, assenting individuals to discuss the study details and confirm eligibility. Eligible clients will be emailed a link via REDCap web-based survey to complete informed consent and baseline measure, the Obsessive Compulsive Inventory-Revised (OCI-R). Individuals unable to access the online survey will be provided with a physical study pack comprising the study information sheet, informed consent form, an OCI-R measure, and postage-paid return envelope. The OCI-R is anticipated to take 5 to 10 minutes to complete. The primary researcher will follow-up on surveys where there has been no response within 1 to 2 weeks of the survey initially being sent. This will occur via either email or telephone call. Results from the OCI-R will be used to make comparisons of results from the ePPOC measure sets, at both participant intake and at completion of each Pain Service programme. This study anticipates recruiting 150 participants. Additionally, through purposeful sampling, 3-6 individuals indicating OCD–Chronic Pain comorbidity, (either by clinical diagnosis or as supported by high OCI-R and ePPOC results) will be approached to participate in a one-on-one semi-structured interview. This interview will be conducted by the primary researcher, a registered clinical psychologist, following the completion of any active Community Pain Service, and will be focused on exploring the experiences of their conditions and pain rehabilitation. Interviewees will also complete an obsession directed self-report measure (Obsessive Beliefs Questionnaire 44 [OBQ-44]) to assist in providing clinical understanding of participant experiences regarding obsessions. Interviews will primarily look to be conducted face-to-face at a venue suitable to both the interviewer and interviewee, with consideration of personal/cultural factors. Video-conferencing options may also be considered in light of distance/travel related issues. It is anticipated that the interview will take approximately 60 minutes in length, with a further 20 minutes to complete the OBQ-44.