Abstract
Background and purpose
The Fear Avoidance Model is used to explain why some patients with acute low back pain develop chronic low back pain (CLBP). Cognitive behavioural therapy (CBT) targeting dysfunctional behavioural cognitions (pain catastrophizing and fear of movement) is recommended.
Purpose: to investigate whether a two-week CBT-based pain management program results in improvement in dysfunctional behavioural cognitions and whether these improved cognitions improve functional outcomes.
Methods and Results
Cohort study including 524 consecutive CLBP-patients. Main outcome: functioning (ODI). Secondary outcomes: pain severity (NRS), pain catastrophizing (PCS), fear of movement (TSK). Assessments: pre- and post-treatment, 1 and 12-months follow-up (FU). Improvement over time was analysed with repeated measures ANOVA. Path analyses were used to examine the influence of pain catastrophizing and fear of movement on functional disability and pain severity. Multiple imputation was used to complete missing data.
Participants with incomplete data (12.8%) did not differ from those with complete data (n= 457). 59% were females, mean age 46 (± 9.5) years, mean CLBP-duration 12 (± 10.8) years. All outcomes significantly improved at post-treatment and a slight significant improvement between post-treatment and 12 months FU was observed. Path analyses showed a direct effect for catastrophizing on post-treatment functioning and an indirect effect for catastrophizing through fear of movement on post-treatment functioning. Comparable results with pain severity as outcome.
Conclusion
A two-week pain management program improved dysfunctional behavioral cognitions and functional outcomes in patients with longstanding CLBP up to one year. Targeting both pain catastrophizing and fear of movement during the program resulted in improved outcomes.
Conflicts of Interest: JK O'Dowd is director of and shareholder in RealHealth
The authors declare that this abstract has not been previously published in whole or substantial part nor has it been presented previously at a national or international meeting.
Sources of Funding:
No funding obtained
