title: A short, intensive cognitive behavioral pain management program reduces health-care use in patients with chronic low back pain: two-year follow-up results of a prospective cohort.
abstract: OBJECTIVE
  Cognitive behavioral interventions are recommended as non-invasive treatment options for patients with chronic low back pain (CLBP). However, most treatment effects are small and short-lived. Although a 2-week intensive pain management program for patients with CLBP seems to be effective, the long-term results are not known. The purpose of this study is to evaluate the stability of the 2-year follow-up results and whether this is reflected in the use of health-care services.
  
  
  METHODS
  A prospective cohort study was performed. Pre-treatment characteristics of patients and data of outcomes obtained at 1-year follow-up were used. At 2-year follow-up a structured interview was conducted following the principles of a post-marketing survey. Outcomes included daily functioning, quality of life, current intensity of pain, disturbance of pain during daily activities, and indicators of the use of pain medication and health-care services.
  
  
  RESULTS
  Of the 90 eligible patients 85 (94%) participated in the post-marketing survey. The 1-year clinical relevant effects are maintained at 2-year follow-up. Effect sizes for functioning and quality of life were large. More than 65% reached preset minimal clinically important differences. At pre-treatment all patients consulted their general practitioner (GP) and medical specialist (MS). At 2-year follow-up 73% reported having consulted neither a GP nor an MS during the previous year. Most of the patients indicated not to use any pain medication (57%) and the percentage patients using opioids have decreased (14%). Moreover, 81% reported to be at work.
  
  
  CONCLUSIONS
  The gained results from selected and motivated patients with longstanding CLBP at 1-year follow-up are stable at 2-year follow-up. Above all, most of the participants are at work and results indicate that the use of both pain medication and health care have decreased substantially.
authors.affiliation: Department Research Development and Education, Sint Maartenskliniek, PO Box 9011, 6500 GM Nijmegen, The Netherlands. m.vanhooff@maartenskliniek.nl
authors.forename: Miranda L
authors.initials: ML
authors.lastname: van Hooff
authors.forename: Werner
authors.initials: W
authors.lastname: Ter Avest
authors.forename: Philip P
authors.initials: PP
authors.lastname: Horsting
authors.forename: John
authors.initials: J
authors.lastname: O'Dowd
authors.forename: Marinus
authors.initials: M
authors.lastname: de Kleuver
authors.forename: Wim
authors.initials: W
authors.lastname: van Lankveld
authors.forename: Jacques
authors.initials: J
authors.lastname: van Limbeek
mesh_terms: D000328:Adult; D002908:Chronic Disease; D015928:Cognitive Behavioral Therapy / Q000379:methods*; D015331:Cohort Studies; D003695:Delivery of Health Care / Q000706:statistics & numerical data*; D004185:Disability Evaluation; D005500:Follow-Up Studies; D006801:Humans; D008137:Longitudinal Studies; D017116:Low Back Pain / Q000523:psychology* / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D059408:Pain Management / Q000379:methods*; D010147:Pain Measurement; D011446:Prospective Studies; D011788:Quality of Life / Q000523:psychology; D016896:Treatment Outcome