A randomized trial of a cognitive-behavioral program for enhancing back pain self care in a primary care setting

Abstract

Back pain is a significant health care problem that has been managed unsatisfactorily in primary care settings. Providers typically address medical issues but do not adequately address patient concerns or functional limitations related to back pain. We evaluated a brief intervention for primary care back pain patients designed to provide accurate information about back pain, instill attitudes favorable towards self care, reduce fears and worries, assist patients in developing personalized action plans to manage their back pain, and improve functional outcomes. Patients enrolled in a large health maintenance organization were invited to participate in an educational program to improve back pain self care skills 6-8 weeks after a primary care back pain visit. Patients (n=226) were randomly assigned to a Self Care intervention or to Usual Care, and were assessed at baseline, 3-, 6-, and 12-months. The intervention involved a two-session Self Care group and an individual meeting and telephone conversation with the group leader, a psychologist experienced in chronic pain management. The intervention was supplemented by educational materials (book and videos) supporting active management of back pain. The control group received usual care supplemented by a book on back pain care. Participants assigned to the Self Care intervention showed significantly greater reductions in back-related worry and fear-avoidance beliefs than the control group. Modest, but statistically significant, effects on pain ratings and interference with activities were also observed.

Cost-effectiveness of guideline-endorsed treatments for low back pain: a systematic review

“…1). Results of two separate studies [18,19] were reported in one paper [20]. These studies had almost identical design features so are referred to as ''Strong et al'' in the current paper.…”

Randomized trial of a DVD intervention to improve readiness to self-manage joint pain

“…Randomized trials with book-only or waiting list controls showed they led to improvements among people with various chronic pain conditions [31,35,44]. However, many people referred to pain programs do not attend or engage [38,42,43], so increasing motivation or 'readiness' to self-manage pain could potentially contribute to more costeffective management of pain across multiple chronic pain populations.…”

Patient satisfaction with a pilot chronic pain management programme in Cape Town, South Africa

“…A multidisciplinary management approach which has been successfully implemented for the management of chronic pain disorders was used as a guideline for the development of a six week outpatient CPMP (Flor et al, 1992, Main and Spanswick, 2000, Moore et al, 2000, Olason, 2004, Ostelo et al, 2005. Studies on the efficacy of CPMP have investigated various models of delivery.…”

“…Studies on the efficacy of CPMP have investigated various models of delivery. These include inpatient programmes ranging from 4-weeks (Williams et al, 1993) to 7-weeks in duration (Olason, 2004), combination inpatient/outpatient programmes (Main and Spanswick, 2000) and six to eight week outpatient programmes (Moore et al, 2000). The CPMP at Groote Schuur Hospital was held once a week for an hour and half over a six week period, a total of nine hours.…”