A short, intensive cognitive behavioral pain management program reduces health-care use in patients with chronic low back pain

Abstract

PurposeCognitive behavioral interventions are recommended as non-invasive treatment options for patients with chronic low back pain (CLBP). However, most treatment effects are small and short-lived. Although a 2-week intensive pain management program for patients with CLBP seems to be effective, the long-term results are not known. The purpose of this study is to evaluate the stability of the 2-year follow-up results and whether this is reflected in the use of health-care services.MethodsA prospective cohort study was performed. Pre-treatment characteristics of patients and data of outcomes obtained at 1-year follow-up were used. At 2-year follow-up a structured interview was conducted following the principles of a post-marketing survey. Outcomes included daily functioning, quality of life, current intensity of pain, disturbance of pain during daily activities, and indicators of the use of pain medication and health-care services.ResultsOf the 90 eligible patients 85 (94%) participated in the post-marketing survey. The 1-year clinical relevant effects are maintained at 2-year follow-up. Effect sizes for functioning and quality of life were large. More than 65% reached preset minimal clinically important differences. At pre-treatment all patients consulted their general practitioner (GP) and medical specialist (MS). At 2-year follow-up 73% reported having consulted neither a GP nor an MS during the previous year. Most of the patients indicated not to use any pain medication (57%) and the percentage patients using opioids have decreased (14%). Moreover, 81% reported to be at work.ConclusionsThe gained results from selected and motivated patients with longstanding CLBP at 1-year follow-up are stable at 2-year follow-up. Above all, most of the participants are at work and results indicate that the use of both pain medication and health care have decreased substantially.

A more global approach to musculoskeletal pain: Expressive writing as an effective adjunct to physiotherapy

“…This result was apparent in the short and long term and is in agreement with literature showing the effects of psychological intervention on pain reduction (e.g. van Hooff et al, 2012). …”

The Michel Benoist and Robert Mulholland yearly European Spine Journal Review

“…It would appear to be the case that although on the various parameters measured, there is no statistical difference overall, these averages mask the fact that more of the excellent and good results are in the fusion group. The value of exercises and cognitive training is assessed in the paper by Van Hooff et al [55]. This paper is a follow-up of their paper in 2010 [56].…”

The Michel Benoist and Robert Mulholland yearly European Spine Journal Review

“…In the July issue Van Hooff et al [32] report the 2-year follow-up results of a prospective cohort treated by a short intensive behavioural pain management program. It is now admitted that a cognitive behavioural approach effectively reduces disability in chronic LBP patients.…”