[Treatment of chronic low back pain through intensive activation - an assessment of 10 years]

Treatment of chronic low back pain is a difficult problem and usually of low effectiveness. Aim of the study was to analyse the effectiveness of a multimodal treatment procedure.

From the basis of functional restoration concepts primarily established in the USA we conceptualized a treatment program which initially was funded by the German ministry of research. Over the years the regimen was modified in several respects (programs of different intensity). From 1990 to 2000 762 patients were treated in this way with one-year follow-up examination.

Patients who were off work had significant differences in psychosocial and pain-related variables in comparison to those patients who were still working. Treatment procedures were in general very effective, although a modification of the program with less treatment (no work-hardening) failed in repeating the same effects. Pain intensity, disability, amount of depression and psychological distress improved significantly as well as work capability and use of the health care system. Nearly all results were seen to stabilize at the 12-month evaluation.

Functional restoration programs for treatment of chronic low back pain have demonstrated effectiveness in several countries. By early use of these programs the high amount of costs due to back pain disability may be consequently reduced. Up to now in Germany these concepts are not well-known and insurance companies as well as the health system do not yet acknowledge them.