Pain centers meet success in dealing with many cases of chronic pain which had been refractory to other therapies. Unfortunately, about one-fourth of all patients who initially do well begin to deteriorate shortly after completion, and within a few months have regressed to pre-treatment levels. In an effort to understand the causes of this regression, the authors surveyed patients who completed the program in 1977 by means of mail questionnaire. The 25 most successful patients were contrasted with an equal cohort of failures (i.e., patients who had met with initial success and subsequent regression). Correlations were also performed among indices of change and other variables. The failure group demonstrated less incentive for maintaining their gains, most continuing to receive financial compensation for their pain. Differences in attitude were revealed, with the failure group more likely to assume a dependent, passive stance. Depression was more characteristic of the failure group and may be causative with respect to deterioration. Most strinkingly, it appeared that the failure group had done little to change their environments, and continued to find reinforcement for pain behavior following discharge. The survey suggests the need for changes in the area of employment for injured workers, as well as further research in attitude measurement and attitude change. More aggressive treatment of depression might reduce the tendency toward regression, as would increased effort to change family dynamics that reward the patient for overt suffering.

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We have evaluated 100 consecutive patients with low-back pain admitted to the Portland Pain Center. The average patient had been disabled for about 6 years, and had had an average of two surgical attempts to improve his symptoms. Most of the patients considered had open claims with their Workmen's Compensation carriers. Significant gains were demonstrated in drug reduction, general well behavior, and increased range of motion and exercise tolerance. The Pain Center setting provides a multidisciplinary approach to the treatment of chronic low-back pain. Significant increases in functional capacity are demonstrated.

Thirty-six patients with low-back pain who had been treated in our multidisciplinary pain center returned for 80-week follow-up evaluations by the staff pscyhologist, physiatrist and physical therapist. Statistically significant gains were maintained in the reduction of prescription analgesics and on 4 measures of physical functioning: (a) long-sittimg-to-toe; (b) straight-leg-raise; (c) knee-to-chest; and (d) overall exercise performance. Despite verbal reports of continuing pain, most patients claimed they were coping much better with it, and they displayed a marked reduction in their utilization of medical resources for further pain treatment. These long-term results suggest that a multidisciplinary approach can offer an effective means of treating chronic low-back pain.