INCORPORATION OF COGNITIVE-BEHAVIORAL TREATMENT INTO THE MEDICAL-CAREOF CHRONIC LOW-BACK PATIENTS - A CONTROLLED RANDOMIZED STUDY IN GERMAN PAIN TREATMENT CENTERS

Cognitive behavioral treatment has been incorporated into standard med ical treatment procedures in German pain centers. Acceptance of the tr eatment by patients and outcome in terms of pain, coping, and disabili ty was investigated. Components of the psychological treatment are edu cation, relaxation and imagery, modifying thoughts and feelings, enhan cement of pleasant activities, and training of good postural habits. T he program was conducted in a group setting in accordance with a treat ment manual and consists of 12 weekly 2.5-h sessions. A two-factor exp eriment with repeated measures on one factor was applied. Ninety-four consecutive patients with low-back pain were randomly assigned to an e xperimental group having a combined medical and cognitive-behavioral t reatment, or to a control group with medical treatment only. Assessmen ts were taken pre-treatment, post-treatment, and - in the treated grou p only - at a 6-months follow-up. At each assessment, patients kept a pain diary over a period of 4 weeks, and filled in self-report questio nnaires. The sample consisted of 36 experimental and 40 control subjec ts at post-treatment. Experimental subjects reported less pain, better control over pain, more pleasurable activities and feelings, less avo idance and less catastrophizing. In addition, disability was reduced i n terms of social roles, physical functions and mental performance. Th e results were maintained at follow-up. Patients who only received med ical treatment showed little improvement. Data indicate that the progr am meets the needs of the patients and should be continued. (C) 1997 E lsevier Science Ireland Ltd.