Back pain in direct patient care providers: early intervention with cognitive behavioral therapy

Back pain and injury are a widespread problem for direct care providers and can lead to disability and job loss. Although most intervention studies focus on the number of reported injuries as the outcome variable, pain is a leading indicator of impending injury. More secondary prevention interventions focusing on early detection and treatment of pain are needed to reduce injuries. The primary aim of this study was to assess the feasibility and effect size of a cognitive behavioral therapy (CBT) intervention to reduce the measures of back pain, stress, and disability in direct care providers working with back pain. The secondary aim was to assess the association between affect and outcome variables, particularly unscheduled work absence, which is a component of disability. This randomized clinical trial recruited 32 registered nurses and nursing assistants with a history of back pain in the past year and assigned them to either an intervention or a control group. The CBT intervention was a weekly stress and pain management session over 6 weeks led by a clinical psychologist. Data for both groups were collected at baseline and at 6 weeks, with work absence data caused by back pain self-reported for 12 weeks. Pain intensity scores declined in the intervention group, indicating a large effect. However, stress scores increased. Depression scores accounted for one-third of the variance in hours absent because of back pain. Although there was a high dropout rate in the intervention group, a cognitive-behavioral intervention shows promise as a secondary prevention intervention.