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Effectiveness of a multimodal treatment program for chronic low-back pain
M Pfingsten1, J Hildebrandt, E Leibing
1Department of Algesiology, Center of Anesthesiology, University of Göttingen, Germany.
Pain
|December 31, 1997
Summary
Multidisciplinary pain programs improve chronic low back pain patients, but coping strategies aren't key predictors for return to work. Psycho-social factors like self-efficacy and reduced disability are better indicators.
Area of Science:
- Rehabilitation Medicine
- Psychology
- Pain Management
Background:
- Multidisciplinary pain programs combine physical and psychological interventions for chronic pain.
- The specific mechanisms driving patient improvement, particularly return to work, require further clarification.
- Cognitive-behavioral models suggest changes in coping strategies are crucial, but evidence is conflicting.
Purpose of the Study:
- To investigate the effectiveness of a multidisciplinary pain program for chronic low back pain patients.
- To identify which factors, including coping strategies and psycho-social parameters, predict return to work.
- To analyze changes in pain, disability, and coping over time.
Main Methods:
- Ninety chronic low back pain patients participated in a multidisciplinary treatment program.
- Coping strategies were assessed using the FEKB inventory, measuring "catastrophizing," "search for information," and "cognitive control."
- Pain intensity, depression, disability, spinal flexibility, and performance were measured pre-treatment, post-treatment, and at 6 and 12 months post-discharge.
Main Results:
- Significant improvements in most measured parameters were observed and stabilized at 6 and 12 months post-treatment.
- Coping strategies showed minimal change and had poor prognostic relevance for return to work.
- Self-reported return-to-work potential, pension application status, prior absence length, and decreased subjective disability were significant predictors of returning to work.
Conclusions:
- While multidisciplinary programs are effective, changes in coping strategies are not primary drivers for return to work in chronic low back pain patients.
- Psycho-social factors, particularly self-perceived ability to return to work and reduced disability, are more predictive of work resumption.
- Future research should focus on patients' beliefs about pain and the interplay between environmental factors and coping demands.