Psychological predictors of substantial pain reduction after minimally invasive radiofrequency and injection treatments for chronic low back pain.
OBJECTIVE
In this post hoc observational study, we investigated psychological predictors of outcome after radiofrequency and injection treatments, commonly performed in the management of chronic low back pain (CLBP).


METHODS
Data, comprising 161 patients (29 eventually lost to follow-up), were obtained from two randomized controlled trials on efficacy of radiofrequency treatment for back pain and sciatica. Subsequently patients were additionally treated in an open prospective follow-up period. Although all groups presented a significant visual analog scale reduction after 3 and 12 months, no additional pain relief after radiofrequency compared with injection treatment was found. Both trial populations showed sufficient similarities. A principal component (factor) analysis was performed on baseline psychometric tests, SF-36, and physical activity variables. We constructed five clinically relevant psychological profiles: "psychologically negative,""adaptive manager,""rigid qualities,""supporting partner," and "strong ego." These were examined as possible predictors of significant pain relief using logistic regression analysis.


RESULTS
The "psychologically negative" dimension showed a negative and the "adaptive manager" dimension a positive prognostic effect on outcome.


CONCLUSIONS
Minimally invasive treatment for CLBP leads to significant pain reduction, including potential placebo effects. However, psychologically vulnerable patients, characterized by, among others, reduced life control, disturbed mood, negative self-efficacy, catastrophizing, high anxiety levels, inadequacy, and poor mental health, tend not to respond to this treatment. Patients characterized by a.o. reduced pain and interference levels, positive expectations, and reasonable physical and social functioning, react more favorably. From both a clinical and a financial perspective, psychosocial evaluation and selection of patients seems appropriate, before applying minimally invasive procedures for CLBP.
van Wijk
Roelof M A W
RM
Department of Anesthesia, The Queen Elizabeth Hospital, University of Adelaide, Adelaide, South Australia, Australia. roelof.vanwijk@nwahs.sa.gov.au
Geurts
Jos W M
JW
Lousberg
Richel
R
Wynne
Herman J
HJ
Hammink
Edwin
E
Knape
Johannes T A
JT
Groen
Gerbrand J
GJ
D002908:Chronic Disease; D003714:Denervation; D006801:Humans; D017116:Low Back Pain / Q000188:drug therapy / Q000523:psychology* / Q000532:radiotherapy*; D008159:Lumbar Vertebrae; D015337:Multicenter Studies as Topic; D009426:Netherlands; D011237:Predictive Value of Tests; D011584:Psychology; D000078702:Radiofrequency Therapy; D016032:Randomized Controlled Trials as Topic; D012044:Regression Analysis; D013256:Steroids / Q000627:therapeutic use; D016896:Treatment Outcome; D021801:Zygapophyseal Joint / Q000187:drug effects / Q000294:innervation
D013256:Steroids