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Eur Spine J. 2019 May 8. doi: 10.1007/s00586-019-05967-6. [Epub ahead of print]

Long-term results of an intensive cognitive behavioral pain management program for patients with chronic low back pain: a concise report of an extended cohort with a minimum of 5-year follow-up.

Author information

1
Department of Orthopedics, Sint Maartenskliniek, P.O. Box 9011, 6500 GM, Nijmegen, The Netherlands. d.groot@maartenskliniek.nl.
2
Department of Research, Sint Maartenskliniek, P.O. Box 9011, 6500 GM, Nijmegen, The Netherlands.
3
Department for Orthopaedic Surgery, Radboud University Medical Center, Nijmegen, The Netherlands.
4
Department of Orthopedics, Sint Maartenskliniek, P.O. Box 9011, 6500 GM, Nijmegen, The Netherlands.
5
The RealHealth Institute - Sint Maartenskliniek, Zevenheuvelenweg 48a, 6571 CK, Berg en Dal, The Netherlands.
6
Weymouth Street Hospital, 42-46 Weymouth Street, Maryleborne, London, W1G 6NP, UK.
7
The RealHealth Institute, 23-31 Beavorlane, London, W6 9AR, UK.

Abstract

PURPOSE:

Treatment options for chronic low back pain (CLBP) include cognitive behavioral interventions. Most of these interventions only have small and short-lived effects. Using strict inclusion criteria for participation in an intensive combined physical and psychological program, encouraging effects were reported at 1-year follow-up. This study evaluates the long-term follow-up results of the same program. The hypothesis is that previously reported results are maintained.

METHODS:

Structured interviews were conducted in a prospective extended cohort with a minimum of 5-year follow-up in a similar fashion as in the 1-year follow-up report. The median follow-up in this cohort was 6.5 years. The extended cohort consisted of 277 patients (85% response).

RESULTS:

Outcomes include daily functioning, quality of life, current pain intensity, pain disturbance in daily activities and indicators of the use of pain medication and healthcare services. The previously reported positive 1-year follow-up results were maintained at a minimum of 5-year follow-up. Disability as measured with the Oswestry disability index (ODIv2.1a) decreased from 40 to 27 in the first year. This positive result was maintained at the 6.5-year follow-up with an ODI of 28. Pain intensity (NRS 0-100) improved from 60 to 39 in the first year, and at 6.5 years, this had further improved to 33. Improvement in quality of life (SF 36) at 1-year follow-up was maintained at 6.5-year follow-up, and healthcare consumption had decreased substantially as measured with doctor visits and analgesics used for CLBP.

CONCLUSION:

Selected and motivated patients with longstanding CLBP improve fast after an intensive combined physical and psychological program in daily functioning, pain and quality of life. Positive 1-year results are maintained, and healthcare utilization was still reduced at a minimum of 5-year follow-up. These slides can be retrieved under Electronic Supplementary Material.

KEYWORDS:

Cognitive therapy; Low back pain; Pain management

PMID:
31069525
DOI:
10.1007/s00586-019-05967-6

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