Psychosocial differences as predictors for recovery from chronic low back pain following manipulation, stabilizing exercises and physician consultation or physician consultation alone.
OBJECTIVE
Three psychosocial profile groups are introduced in the Multidimensional Pain Inventory for chronic pain patients. Patients with the dysfunctional profile have shown a more favourable outcome after multidisciplinary treatments, due to the suggested effects of specific psychosocial treatment elements. In this study we explored, among patients with chronic low back pain, whether the Multidimensional Pain Inventory patient profile groups might respond differently to treatment without planned psychosocial elements.


METHODS
Of 204 voluntarily recruited patients with chronic low back pain, 102 were randomized to a combined manipulation, exercise and physician consultation group (called the combination group) and 102 to a consultation-alone group.


RESULTS
Although all subjects showed improvement during follow-up both on the Oswestry index and the Visual Analogue Scale, the dysfunctional profile patients in the combination group improved the most. Their high pre-treatment ratings on Oswestry and Visual Analogue-scales fell at the 5- and 12-month follow-ups to the same level as those of the adaptive copers or interpersonally distressed patients, and they were on a significantly lower level than the dysfunctional profile patients in consultation group during follow-up. All dysfunctional profile patients also showed a decrease in affective distress, equally in combination and consultation groups.


CONCLUSIONS
We suggest that dysfunctional profile patients are more sensitive to respond even to treatment without any specific psychosocial elements. This should be considered when evaluating any treatment effects. Among dysfunctional profile patients, pain-related anxiety and decreased acceptance of pain may contribute to their sensitivity to treatment.
Riipinen
Markku
M
Orton Orthopaedic Hospital, Invalid Foundation, FIN-00280 Helsinki, Finland. markku.riipinen@invalidisaatio.fi
Niemistö
Leena
L
Lindgren
Karl-August
KA
Hurri
Heikki
H
D000328:Adult; D002908:Chronic Disease; D005081:Exercise Therapy; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D017116:Low Back Pain / Q000523:psychology / Q000534:rehabilitation* / Q000628:therapy; D008297:Male; D008349:Manipulation, Orthopedic; D010147:Pain Measurement; D011379:Prognosis; D020127:Recovery of Function; D012017:Referral and Consultation; D012944:Social Support; D016896:Treatment Outcome