title: Two psychological interventions are effective in severely disabled, chronic back pain patients: a randomised controlled trial.
abstract: BACKGROUND
  Many pain patients appreciate biofeedback interventions because of the integration of psychological and physiological aspects. Therefore we wanted to investigate in a sample of chronic back pain patients whether biofeedback ingredients lead to improved outcome of psychological interventions.
  
  
  METHODS
  One hundred and twenty-eight chronic back pain patients were randomly assigned to cognitive-behavioural therapy (CBT), cognitive-behavioural therapy including biofeedback tools (CBT-B) or waitlist control (WLC). The sample was recruited from a highly disabled group including many patients with low education status and former back surgeries. Measures on pain, physical functioning, emotional functioning, coping strategies and health care utilisation were taken at pretreatment, posttreatment and 6 months of follow-up.
  
  
  RESULTS
  The results indicated significant improvements on most outcome measures for CBT-B and CBT in comparison to WLC. CBT-B and CBT were equally effective (e.g. ITT effect sizes for pain intensity: CBT-B, 0.66 (95% CI 0.39-0.95); CBT, 0.60 (95% CI 0.33-0.87)).
  
  
  CONCLUSIONS
  In conclusion, biofeedback ingredients did not lead to improved outcome of a psychological intervention. Cognitive-behavioural treatment as a "package" of respondent, operant and cognitive interventions was effective for ameliorating pain-related symptoms for chronic back pain patients treated in an outpatient setting. The high treatment acceptability associated with biofeedback ingredients can also be achieved with pure psychological interventions.
authors.affiliation: Section for Clinical Psychology and Psychotherapy, Philipps-University of Marburg, Gutenbergstr. 18, 35032 Marburg, Germany. julia.glombiewski@staff.uni-marburg.de
authors.forename: Julia Anna
authors.initials: JA
authors.lastname: Glombiewski
authors.forename: Jens
authors.initials: J
authors.lastname: Hartwich-Tersek
authors.forename: Winfried
authors.initials: W
authors.lastname: Rief
mesh_terms: D000328:Adult; D001416:Back Pain / Q000523:psychology* / Q000628:therapy*; D001676:Biofeedback, Psychology / Q000379:methods; D002908:Chronic Disease; D015928:Cognitive Behavioral Therapy / Q000379:methods; D003131:Combined Modality Therapy; D006233:Persons with Disabilities / Q000523:psychology*; D004644:Emotions; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D010147:Pain Measurement / Q000379:methods; D012494:Sampling Studies; D012720:Severity of Illness Index; D016896:Treatment Outcome