["Pain under discussion--stages of chronicity and treatment outcome]

"Pain under Discussion" aims at the education of patients with chronic headache and back pain by applying a standardized manual with detailed instructions for seven sessions in a group setting. Apart from encouraging a reconceptualization of the patients' pain experience with reference to a bio-psycho-social model, the program provides information about the vicious circle of pain, avoidance and demoralization and relies heavily on behavioral assumptions about the process of chronicity. Patients are offered participation in progressive relaxation according to Jacobson, they learn to engage in pleasant activities, and are instructed to more and more maintain an upright body position during various activities of every day life. The study evaluates the outcome of the training. Moreover, as an algorithm for grading pain patients according to their level of chronicity has recently been developed by Gerbershagen, we use this algorithm in order to investigate the relationship between the outcome of treatment and the assigned level of chronicity. In addition, we test the assumption that a higher level of chronicity is related to a lower level of psychological functioning pre treatment.

35 patients with a diagnosis of a chronic low back syndrome (Toronto classification) and 30 patients with a diagnosis of tension-type headache (IHS classification) have been recruited from six facilities specialized in the treatment of chronic pain patients. An average pain duration of 11 years indicates a long career as a pain patient. At the initial assessment, patients were assigned to three levels of chronicity according to the algorithm. Before and six month after completion of the program, they were asked to fill in a pain diary and well-established pain questionnaires with good psychometric properties under inclusion of pain intensity and control over pain (diary) as well as sensory and affective dimensions of pain, coping, self-instructions, disability, well-being and depression.

Analyses of variance indicate a close relationship between a higher level of chronicity and a lower degree of psychological functioning. T-Tests for paired samples and Bonferroni correction show significant changes in the affective dimension of the pain experience, in coping styles and self-instructions, as well as in well-being, when follow-up data are compared with the initial values. This indicates a favorable outcome of the training. Analysis of covariance, on the other hand, demonstrate that the outcome does not depend on the level of chronicity at the first assessment.

Irrespective of the initial pain grading of the patients the training program has proven to be effective with regard to different outcome measures.