Long-term effects of rehabilitation and prevention of further chronification of pain among patients with non-specific low back pain.

BACKGROUND

Psychological factors influence the development and persistence of chronic low back pain (CLBP) and may impair the psychosocial rehabilitation success.

OBJECTIVE

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.

METHODS

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.

RESULTS

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.

CONCLUSIONS

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.