EFFECTIVENESS OF A MULTIMODAL TREATMENT PROGRAM FOR CHRONIC LOW-BACK-PAIN

In recent years, multidisciplinary pain programs were seen to successf ully treat patients by basing treatment on a combination of physical e xercise and psychological interventions. However, in spite of their ef fectiveness, it still remains to be clarified exactly which features o f these programs were responsible for patient improvement. Cognitive-b ehavioral models posit that improvement is due, in part, to changes in patient coping strategies. Nonetheless, as reflected by the conflicti ng opinions present in the literature, it is questionable whether a so -called 'cognitive shift' is an accurate indicator for return to work of disabled patients. Ninety patients with chronic low back pain took part in a multidisciplinary treatment program. Therapeutic environment reinforces wellness behavior and enhances the patients' sense of cont rol over their pain and resulting disability. The main therapeutic tar get point was to facilitate return to work. Ways of coping were measur ed by a well studied coping inventory in the German language (FEKB). F actor analysis revealed three factors: 'catastrophizing', 'search for information' and 'cognitive control'. In addition, assessment included measurements of pain intensity, depression, disability, flexibility o f the lumbar spine, and different performance parameters. All of them were measured prior to and at the end of treatment, and following inte rvals of 6 and 12 months after discharge from program. Measurements sh owed significant changes over time, but more importantly, nearly all r esults were seen to stabilize at the 6- and 12-month evaluation follow ing treatment. The coping strategies demonstrated little or poor chang e. In addition, coping measures and change in coping behavior showed p oor prognostic relevance. But other psyche-social parameters like self -evaluation of potential return-to-work, application for pension, the length of pre-absence from work, and a decrease in subjective disabili ty following treatment were effective indicators for 'back-to-work'. O ther objective parameters, such as medical history, physical impairmen t and general physical variables were seen to have little predictive v alue in determining a return to work. The results suggest that the pri mary target point for further investigation is the analysis of the pat ients' beliefs about their pain. Our results indicate that future rese arch must be attentive to the complex interactions between environment al factors and the coping demands posed by the specific nature of pain problems. (C) 1997 International Association for the Study of Pain. P ublished by Elsevier Science B.V.