The efficacy of a risk factor-based cognitive behavioral intervention and electromyographic biofeedback in patients with acute sciatic pain; An attempt to prevent chronicity

Study Design. An investigation of the efficacy of an individually scheduled , risk factor-based cognitive behavioral therapy and a standardized electro myographic biofeedback intervention in the prevention of chronicity in pati ents with acute sciatica and psychosocial risk factors for chronicity. Objectives. To investigate the possibility of enhancing pain relief and pre venting chronicity in patients with acute sciatica, based on a screening fo r psychosocial highrisk factors of chronification. Summary of Background Data. Psychological interventions were evaluated main ly in patients with chronic low back pain. Numerous randomized trials have demonstrated their efficacy, were as the amount of pain relief was found to be marginal. Methods Subjective and behavioral outcome parameters were compared with the respective parameters in age-, gender-, and diagnosis-matched high- and lo w-risk patients. No additional behavioral treatment for in-patient medical therapy was offered tot he patients. Outcome of these patients also was com pared with that of a group of refusers of behavioral therapy. Psychological , functional, and behavioral variables were measured before and after treat ment and at 3- 6-, 12- and 18-month follow-up visits. Changes over time, gr oup differences, and possible group x time interactions were analyzed by an alysis of variance and nonparameteric comparisons. Results. Data analysis showed a statistically and clinically significant, b eneficial effect of both behavioral interventions. However, risk factor-bas ed cognitive behavioral therapy was superior to electromyographic biofeedba ck intervention with respect to pain relief and application for early retir ement. The cognitive behavioral therapy showed a similar good outcome (e.g. 90% showed a clinical significant pain reduction) as the low-risk patients (83% pain reduction). High risk patients and refusers of therapy showed a poor outcome in pain (33% and 20% pain reduction, respectively), disability , and work performance. Conclusions. Individually scheduled, risk factor-based cognitive behavior t herapy could be a beneficial treatment modality, which can be offered, in a ddition to a medical treatment, to patents with acute sciatica and psychoso cial high risk factors for chronicity. It may be an effective way to preven t chronification in these patients.