Preventing progression to chronicity in first onset, subacute low back pain: an exploratory study.
OBJECTIVE
To evaluate the effects of a behavioral medicine intervention, relative to an attention control, in preventing chronic pain and disability in patients with first-onset, subacute low back pain (LBP) with limitations in work-role function.


METHODS
A 2-group, experimental design with randomization to behavioral medicine or attention control groups.


METHODS
Orthopedic clinic at a Naval Medical Center.


METHODS
Sixty-seven participants with first-onset LBP of 6 to 10 weeks of duration and impairment in work function, of whom 50 completed all 4 therapy sessions and follow-up 6 months after pain onset.


METHODS
Four 1-hour individual treatment sessions of either behavioral medicine, focused on back function and pain education, self-management training, graded activity increases, fear reduction, and pain belief change; or attention control condition, focused on empathy, support, and reassurance.


METHODS
The primary outcome was proportion of participants classified as recovered, according to pre-established clinical cutoffs on standardized measures, signifying absence of chronic pain and disability at 6 months after pain onset. Secondary analyses were conducted on pain, disability, health status, and functional work category. Intervention credibility and pain belief manipulation checks were also evaluated.


RESULTS
Chi square analyses comparing proportions recovered at 6 months after pain onset for behavioral medicine and attention control participants found relative rates of 52% versus 31% in the modified intent-to-treat sample (P=.09) and 54% versus 23% for those completing all 4 sessions and 6-month follow-up (P=.02). At 12 months, 79% of recovered and 68% of chronic pain participants still met criteria for their respective groups (P<.0001). Recovered participants also had higher rates of functional work status recovery at 12 months (recovered: 96% full duty and 4% light duty; chronic pain: 61% full duty, 18% light duty, and 21% medical discharge, respectively; P=.03).


CONCLUSIONS
Early intervention using a behavioral medicine rehabilitation approach may enhance recovery and reduce chronic pain and disability in patients with first-onset, subacute LBP. Effects are stronger for participants attending all 4 sessions and the follow-up assessment.
Department of Psychology, VA San Diego Healthcare System, San Diego, CA, USA.
Mark A
MA
Slater
Anne L
AL
Weickgenant
Melanie A
MA
Greenberg
Dennis R
DR
Wahlgren
Rebecca A
RA
Williams
Christian
C
Carter
Thomas L
TL
Patterson
Igor
I
Grant
Steven R
SR
Garfin
John S
JS
Webster
J Hampton
JH
Atkinson
D000328:Adult; D001524:Behavioral Medicine / Q000379:methods*; D002908:Chronic Disease; D018450:Disease Progression; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D017116:Low Back Pain / Q000145:classification / Q000534:rehabilitation*; D008297:Male; D008875:Middle Aged; D010147:Pain Measurement; D010353:Patient Education as Topic / Q000379:methods; D026741:Physical Therapy Modalities; D011788:Quality of Life; D016896:Treatment Outcome