Investigating patient expectations and treatment outcome in a chronic low back pain population

Abstract

ObjectiveThis study aimed to measure the outcomes that patients consider clinically meaningful across four treatment domains – (1) pain, (2) fatigue, (3) emotional distress, and (4) level of interference – and determine if patients met their own success criteria. Additionally, the role of expectations in treatment outcome was examined. This study also aimed to determine how change in levels of pain, fatigue, disability, and level of interference varied according to the type of treatment delivered to participants.PatientsForty-seven chronic low back pain patients were recruited from university-affiliated pain clinics.DesignThe study design was longitudinal, consisting of two randomly assigned treatment conditions. The first treatment condition used opioid medication only and the second used both opioid medication and brief cognitive behavioral therapy. Pre- and post-treatment assessments were conducted, which occurred approximately 3 months after the initiation of treatment.Outcome measuresA patient-centered outcomes questionnaire was completed by participants at both pre- and post-treatment assessment.ResultsResults suggest that patients did not meet their own success criteria in treatment across any of the four domains. There was a significant main effect of time for level of pain indicating that both treatment groups had a decrease in their level of pain at post-treatment, F(1, 45) = 11.98, P < 0.001. There was a significant main effect of time for level of interference domain indicating that both groups experienced a reduction in the level of pain-related interference with daily activities, F(1, 45) = 5.46, P < 0.05. There were no significant effects of time for emotional distress or fatigue or any significant group by time interactions. Contrary to our hypothesis, no significant correlations were found between pretreatment expectations and usual level ratings at post-treatment across the four domains.ConclusionPatients sought larger reductions in pain, fatigue, level of distress, and level of interference than they attained at post-treatment. Enhancing opioid treatment with brief cognitive behavioral therapy did not yield additional improvements for the four domains assessed in patients with chronic low back pain.

Eye Movement Desensitization and Reprocessing vs. Treatment-as-Usual for Non-Specific Chronic Back Pain Patients with Psychological Trauma: A Randomized Controlled Pilot Study

“…In a larger randomized controlled trial, prognostic variables for responders should be identified to foster the allocation of patients to treatment that is appropriate for them. Because existing treatments only have low to moderate effects (5–7) and fail to meet patients’ success criteria (8, 9), our results are promising because the treatment seemed to meet patients’ success criteria and clinically relevant changes were suggested for half of the treated patients. However, due to our pilot study design, results should be interpreted with caution.…”

“…Although there are many approaches to treating nsCBP, unfortunately, treatment in these patients has often limited success (5–7) and fails to meet patients’ success criteria (8, 9). This might be the case because many of nsCBP patients report high emotional distress (10–13), but particularly for nsCBP patients with high degrees of emotional distress, classic pain-psychotherapeutic approaches are often insufficient (14).…”

Patients’ perceived needs for medical services for non-specific low back pain: A systematic scoping review

“…Twenty-three papers discussed the patients’ perceived role of the medical practitioner in the management of LBP[ 25 , 37 , 38 , 40 , 43 , 50 , 52 , 53 , 59 , 61 , 67 , 69 , 73 , 74 , 79 – 85 ]. A consistent theme that emerged from patients recruited from general practice [ 69 , 81 , 84 , 86 ], the community[ 43 , 60 ] and tertiary care was the need to obtain a diagnosis and a cause of the pain[ 37 , 38 , 59 , 60 , 67 , 69 , 79 , 81 , 84 ]. Other reasons for seeking medical care included a need to obtain medications for pain relief[ 50 , 51 , 61 , 80 ], to receive advice and discussion of options for LBP management[ 38 , 61 , 85 ], to receive sickness certification and legitimation of their back pain[ 25 , 51 , 52 ].…”

Cross-cultural adaptation of the German Pain Solutions Questionnaire: an instrument to measure assimilative and accommodative coping in response to chronic pain

“…Most CLBP patients have tried several interventions to cure their pain or get more control over it 1. The search for full recovery can involve great effort; despite this effort, the majority of attempts remain unsuccessful 2–4. Repeated failures in controlling pain can lead to less pain tolerance, more worry, and fear or catastrophic thinking, thus opening up new areas of concern 5–7…”