title: Short-term cognitive-behavioral treatment in multicultural primary care of patients with longstanding backache.
abstract: The efficacy of cognitive-behavioral therapy in multi-cultural primary care patients with longstanding backache is not evaluated. The purpose of this study was to investigate the outcome of a four weekly-treatment given by primary care physicians regarding pain-related worry, depression and severe pain and to determine which social, clinical or gender factors were associated with outcome.The study group consisted of 245 patients in consecutive order from 19 countries, 18 to 45 years, entering rehabilitation program because of longstanding backache. Prevalences of pain-related worry and depression and severe pain was counted and compared before and after. Logistic regression was used to calculate the odds (OR; 95% CI) for persistent pain-related worry and/or persistent depression and severe pain (VAS ≥ 50). The prevalences of pain-related worry and depression were both significantly lower after treatment (pain-related worry 83% before vs. 38% after; depression 43% before vs. 31% after). Also the number of patients scoring ≥ 50 VAS was a little, but significantly, fewer (68% vs. 61%). Use of interpreter doubled the risk of having persistent pain-related worry (OR 2.1; 95% CI 1.1-4.1) but the risk was not significant regarding persistent depression (OR 1.8; 0.6-5.4). The rating of VAS rating ≥ 50 after treatment was twice as high, OR 2.3 (95% CI 1.1-4.6) in the 38-45 year old age group. To conclude, a focus on pain ideas reduced pain-related worry and depression in these patients with various sociocultural backgrounds and longstanding backache.
authors.affiliation: Centre for Family and Community Medicine, Karolinska Institutet, Sweden. marina.taloyan@sll.se
authors.forename: Marina
authors.initials: M
authors.lastname: Taloyan
authors.forename: Hassan
authors.initials: H
authors.lastname: Alinaghizadeh
authors.forename: Monica
authors.initials: M
authors.lastname: Löfvander
mesh_terms: D000328:Adult; D000349:Africa / Q000208:ethnology; D001208:Asia / Q000208:ethnology; D001416:Back Pain / Q000208:ethnology / Q000523:psychology / Q000628:therapy*; D059350:Chronic Pain / Q000208:ethnology / Q000523:psychology / Q000628:therapy*; D015928:Cognitive Behavioral Therapy / Q000379:methods*; D018864:Cultural Diversity; D003863:Depression / Q000208:ethnology / Q000523:psychology / Q000628:therapy*; D054242:Emigrants and Immigrants / Q000523:psychology; D005060:Europe / Q000208:ethnology; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D008877:Middle East / Q000208:ethnology; D011320:Primary Health Care / Q000379:methods*; D011614:Psychotherapy, Brief / Q000379:methods*; D013020:South America / Q000208:ethnology; D013548:Sweden; D016896:Treatment Outcome; D055815:Young Adult
keywords: Pain-related worry; cognitive-behavioral treatment; cultural diversity; depression; intervention; primary health care; severe pain