Schmerz. 1996 Dec 16;10(6):326-44. doi: 10.1007/s004829600036.
[Multidisciplinary treatment program on chronic low back pain, part 3. Psychosocial aspects].
Schmerz (Berlin, Germany)
[Article in German]
M Pfingsten, C Franz, J Hildebrandt, P Saur, D Seeger
Affiliations
Affiliations
- Schwerpunkt Algesiologie, Zentrum Anaesthesiologie, Rettungs- und Intensivmedizin, Georg-August-Universität Göttingen, Robert-Koch-Strasse 40, D-37075 Göttingen.
PMID: 12799844
DOI: 10.1007/s004829600036
Abstract
PROBLEM: The majority of authors agree today that psychosocial factors have more influence on a successful treatment of chronic back pain than other variables, in particular medical findings. Therefore treatments aim to integrate psychotherapeutic intervention in order to lessen emotional impairment, to change behavioral patterns (which advocate rest and the avoidance of physical activity), and to change cognitive attitudes and fears concerning exercise and work ability. Nevertheless, the interplay of cognitive measures and disability in treatment programs still remains an unclear issue.
METHODS: Ninety disabled patients with chronic low back pain were admitted to an 8-week outpatient program of functional restoration and behavioral support. The program consisted of a pre-program (education, stretching and calisthenic exercises) and an intensive treatment period (physical exercises, back school education, cognitive behavioral group therapy, relaxation training, occupational therapy, vocational counseling), which took place for 5 weeks, 7 h a day, as an outpatient program. The targets of the psychological interventions were (a) to change maladaptive behavior (inactivity, social withdrawal) and increase the patient's activity level at home, (b) to alter maladaptive cognitions (somatization, catastrophizing, passive expectations concerning treatment) and to improve their own positive coping skills, (c) to identify and stop operant conditioned behavior, and (d) to prevent depressive symptoms and strengthen the level of emotional control. The program's philosophy encouraged the patients' active efforts to improve their functional status within a therapeutic environment that reinforced positive behavior traits conductive to getting well. The main therapeutic target was to facilitate a return to work. Apart from a medical examination and a personal interview, the patients' physical impairment, pain descriptions, and psychological distress (according to different criteria for evaluation) were also measured. This included variables such as depression, psychovegetative complaints, quality of life and workplace satisfaction, disability, and coping with disease. Measurements were repeated at the end of the 8-week program, and following 6- and 12-month intervals.
RESULTS: In comparison with the initial values, a statistically significant improvement became evident in reducing pain, disability, depression, and psychovegetative signs (P < 0.001). Nearly all results remained stable at the 6- and 12-months examinations. Apart from these results, coping measurements demonstrated little improvement in the three factorial coping dimensions. By use of regression analyses, a differentiated description of psychosocial connections became apparent in three different ways of coping (catastrophizing, searching for information, cognitive control) and parameters of disability. Disability levels corresponded poorly with pain descriptions, physical impairment and coping dimensions. This result indicates that disability should be viewed as a separate component in assessing the patients' description of low back pain.
CONCLUSION: An analysis of coping dimensions demonstrated that current cognitive measures might be too general to explain low back disability adequately. In addition, the results indicate that the use of the 'catastrophizing' factor as a separate variable is questionable, since it may simply be a symptom of depression. The relevance of coping as a sensitive parameter for change is also addressed. It is suggested that an alteration in coping strategies may be an important treatment effect, but is subject to individual prerequisites to maximize treatment response. Thus, future research must focus on the complex interactions between personality variables, environmental factors, and the coping demands posed by the specific nature of pain problems. A more lengthy evaluation of so-called 'fear-avoidance beliefs' in combination with 'disability' and coping dimensions could possibly lead to further treatment on the development of chronicity in chronic low back pain patients.
References
- Schmerz. 1990 Mar;4(1):1-6 - PubMed
- J Consult Clin Psychol. 1994 Feb;62(1):172-9 - PubMed
- Soc Sci Med. 1984;19(12):1339-45 - PubMed
- Phys Ther. 1992 Apr;72(4):279-90; discussion 291-3 - PubMed
- Schmerz. 1995 Jul;9(4):206-11 - PubMed
- Spine (Phila Pa 1976). 1984 Mar;9(2):204-8 - PubMed
- Pain. 1991 Jan;44(1):5-28 - PubMed
- Pain. 1990 Jun;41(3):295-301 - PubMed
- Pain. 1994 Oct;59(1):79-83 - PubMed
- Pain. 1989 Feb;36(2):197-207 - PubMed
- Pain. 1992 May;49(2):221-30 - PubMed
- J Consult Clin Psychol. 1991 Jun;59(3):431-8 - PubMed
- Pain. 1988 Sep;34(3):231-44 - PubMed
- Pain. 1991 Dec;47(3):249-83 - PubMed
- Spine (Phila Pa 1976). 1992 Jan;17(1):42-52 - PubMed
- Arthritis Rheum. 1988 May;31(5):593-601 - PubMed
- Spine (Phila Pa 1976). 1991 Jun;16(6):683-5 - PubMed
- Arch Phys Med Rehabil. 1988 Aug;69(8):579-82 - PubMed
- J Occup Rehabil. 1991 Sep;1(3):185-95 - PubMed
- Spine (Phila Pa 1976). 1995 Feb 15;20(4):478-84 - PubMed
- Pain. 1986 Jul;26(1):33-43 - PubMed
- Spine (Phila Pa 1976). 1992 Jun;17(6):663-71 - PubMed
- J Consult Clin Psychol. 1982 Oct;50(5):757-65 - PubMed
- Science. 1977 Apr 8;196(4286):129-36 - PubMed
- J Psychosom Res. 1979;23(2):149-54 - PubMed
- Pain. 1991 May;45(2):111-21 - PubMed
- J Consult Clin Psychol. 1986 Dec;54(6):760-8 - PubMed
- Gesundheitswesen. 1994 Feb;56(2):95-102 - PubMed
- Spine (Phila Pa 1976). 1991 Jan;16(1):1-6 - PubMed
- Spine (Phila Pa 1976). 1988 Dec;13(12):1423-7 - PubMed
- Pharmacopsychiatry. 1988 Nov;21(6):453-5 - PubMed
- Spine (Phila Pa 1976). 1988 Jun;13(6):681-5 - PubMed
- Pain. 1989 Apr;37(1):67-75 - PubMed
- Psychother Psychosom Med Psychol. 1988 Sep-Oct;38(9-10):328-32 - PubMed
- Spine (Phila Pa 1976). 1987 Sep;12(7):632-44 - PubMed
- Pain. 1986 Mar;24(3):343-53 - PubMed
- Pain. 1990 Mar;40(3):293-301 - PubMed
- Schmerz. 1988 Jun;2(2):82-8 - PubMed
- Pain. 1991 Apr;45(1):35-43 - PubMed
- Pain. 1988 Jun;33(3):323-31 - PubMed
- Clin Orthop Relat Res. 1992 Jun;(279):101-9 - PubMed
- J Nerv Ment Dis. 1982 Jul;170(7):381-406 - PubMed
- Schmerz. 1996 Feb 15;10(1):47-52 - PubMed
- J Psychosom Res. 1987;31(3):393-400 - PubMed
- Pain. 1985 Mar;21(3):289-94 - PubMed
- J Consult Clin Psychol. 1981 Aug;49(4):517-25 - PubMed
- Pain. 1991 Sep;46(3):287-98 - PubMed
- J Clin Psychiatry. 1984 Mar;45(3 Pt 2):30-8 - PubMed
- Pain. 1990 Jun;41(3):283-93 - PubMed
- Pain. 1986 Mar;24(3):365-72 - PubMed
- Clin Orthop Relat Res. 1992 Jun;(279):21-34 - PubMed
- Pain. 1988 Nov;35(2):129-40 - PubMed
- Spine (Phila Pa 1976). 1992 Jun;17(6):617-28 - PubMed
- J Consult Clin Psychol. 1982 Aug;50(4):562-75 - PubMed
- J Occup Rehabil. 1991 Sep;1(3):207-16 - PubMed
- Pain. 1993 Feb;52(2):157-68 - PubMed
- Schmerz. 1994 Jun;8(2):100-10 - PubMed
- Pain. 1984 Jul;19(3):209-33 - PubMed
- Pain. 1990 Feb;40(2):171-82 - PubMed
- Schmerz. 1991 Mar;5(Supplement 1):S80-7 - PubMed
- Pain. 1991 Jan;44(1):51-6 - PubMed
- J Behav Med. 1988 Jun;11(3):251-65 - PubMed
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