A cognitive-behavioral group intervention as prevention for persistent neck and back pain in a non-patient population: a randomized controlled trial

Given the demand-for interventions that may prevent the development of pers istent musculoskeletal pain problems, we investigated the effects of a cogn itive-behavioral program in a group of non-patients with neck or back pain symptoms. Two hundred and fifty-three people selected from a population stu dy were invited to participate. These people had experienced four or more e pisodes of relatively intense spinal pain during the past year but had not been out of work more than 30 days. Participants were randomly assigned to either a cognitive-behavioral group intervention or a treatment as usual co mparison group. The experimental group received a standardized six-session program, provided by a trained therapist according to a manual. A significa nt overall analysis at the 1-year follow-up showed that the cognitive-behav ioral group produced better results on 26 of the 33 outcome variables. Grou p comparisons indicated that the cognitive-behavioral group, relative to th e comparison group, had significantly better results with regard to fear-av oidance beliefs, number of pain-free days, as well as the key variable of s ick leave. Participation in the cognitive behavioral group reduced the risk fdr long-term sick leave during the follow-up by threefold. Thus, despite the strong natural recovery rate for back pain, the cognitive-behavioral in tervention produced a significant preventive effect with regard to disabili ty. (C) 2001 International Association for the Study of Pain. Published by Elsevier Science B.V. All rights reserved.