Outcome quality of treatment for chronic low back pain under primary care conditions

Background. Little is known about the outcome quality of treatment for chro nic low back pain under primary care conditions in Germany. Methods. All physicians (2100) of middle Franconia, a region of Bavaria wit h 1.6 million inhabitants, involved in outpatient management were asked to include consecutively patients who suffered from low back pain of at least 4 weeks' duration without decreasing intensity. Before and after a 6-month interval patients documented the following outcome data in a questionnaire: pain intensity during the last 24 hours (numerical rating scale), pain-dep endent disability (Brief Pain Inventory, German version), health-related qu ality of life (SF-36, German version), depression (Allgemeine Depressionssk ala), pain chronification state (Mainz Pain Staging System) and the days of inability to work within 3 months before start and end of the interval. Tr eatment of patients was not standardized and included the natural spectrum of non-surgical therapies for low back pain except multimodal pain therapy programs. Results. Thirty-five physicians participated in the study. "Before and afte r" data of 157 patients (43+/-12 years) could be analysed. Initially 20% we re classified in pain chronification state 1,57% in state II and 23% in sta te III. The pain intensity, pain-dependent disability, depression and quali ty of life improved significantly but mean differences and effect sizes wer e small (p<0.41). Less than one third of patients improved by 30% or more f rom baseline or by one step in the chronification state of pain. Days off w ork did not change significantly. Predictors for positive therapy response could not be identified. Conclusions. Monodisciplinary treatment procedures are not sufficient to am eliorate problems of patients in advanced chronification states of back pai n.