J Back Musculoskelet Rehabil. 2022;35(6):1257-1268. doi: 10.3233/BMR-210221.
Psychological factors influence the development and persistence of chronic low back pain (CLBP) and may impair the psychosocial rehabilitation success.
To examine the effects of a combined pain competence and depression prevention training compared to the pain competence training alone and as well as the patients' stages of pain on the long-term psychosocial rehabilitation success.
In this controlled multicentre study with cluster-block randomization, patients with CLBP in different stages of pain (I-III) received either pain competence training (control group, CG; n= 255) or combined pain competence and depression prevention training (intervention group, IG; n= 271; per protocol). Depressive symptoms (primary outcome), anxiety, somatization, health status, and average pain intensity (secondary outcomes) were assessed up to 12 months of follow-up. Standardised questionnaires were used to record the outcomes, which were filled out by the patients themselves. Analyses after multiple imputation (N= 1225) were conducted to validate multi- and univariate analyses of variance.
Patients in stage of pain I and II showed significant improvements in depressive symptoms, anxiety, mental health, and average pain intensity at the 12-month follow-up, irrespective from treatment condition.
Multidisciplinary rehabilitation seems to be appropriate for patients with CLBP in stage of pain I and II. However, patients in stage of pain III need more psychological treatments to manage their mental comorbidities.
心理因素会影响慢性下背痛（CLBP）的发展和持续，并可能损害心理社会康复的成功。
研究疼痛能力和抑郁预防培训的综合效果与单独进行疼痛能力培训的效果以及患者的疼痛阶段对长期心理社会康复成功的影响。
这是一项具有集群块随机分组的对照性多中心研究，患有不同疼痛阶段（I-III 期）的慢性下背痛患者接受疼痛能力培训（对照组，CG；n=255）或疼痛能力和抑郁预防培训的综合治疗（干预组，IG；n=271；按方案）。抑郁症状（主要结果）、焦虑、躯体化、健康状况和平均疼痛强度（次要结果）在 12 个月的随访中进行评估。使用标准化问卷记录患者自身填写的结果。采用多次插补法（N=1225）进行分析，以验证多变量和单变量方差分析。
无论治疗条件如何，疼痛 I 期和 II 期的患者在 12 个月的随访中，抑郁症状、焦虑、心理健康和平均疼痛强度都有显著改善。
多学科康复似乎适用于疼痛 I 期和 II 期的慢性下背痛患者。然而，疼痛 III 期的患者需要更多的心理治疗来管理他们的精神合并症。
