title: Impact of a multidisciplinary pain program for the management of chronic low back pain in patients undergoing spine surgery and primary total hip replacement: a retrospective cohort study.
abstract: BACKGROUND
  Low back pain is a very common disorder. In this field chronic low back pain represents a special challenge. The management of chronic low back pain consists of a range of different intervention strategies. Usually operative intervention should be avoided if possible. However, there are constellations were surgical therapy in patients with chronic low back pain seems to be meaningful. The aim of this study was to investigate the clinical outcomes after spine surgery and hip replacement in patients with chronic low back pain after undergoing a structured rehabilitation program including cognitive - behavioral therapy.
  
  
  METHODS
  From January 1, 2007 to January 1, 2010 patients were indicated for total hip replacement (THA) or spine surgery after receiving inpatient multidisciplinary pain programs including cognitive - behavioral therapy at our orthopedic institute with a specialized unit for the rehabilitation of chronic pain patients. Indications for surgery were based on the synopsis of clinical and imaging findings and on positive effects after local injections during the multidisciplinary pain program. The tools for assessment included follow-up at 6 and 12 months and analyses of pain, chronicity, physical functioning and depression.
  
  
  RESULTS
  Of the 256 patients admitted for multidisciplinary pain program, fifteen were indicated to benefit from a surgical intervention during multidisciplinary pain program. Ten patients received spine surgery. THA was indicated in five patients. In all cases, the peri- and postoperative clinical courses were uneventful. Only two of the patients subjected to spine surgery and three patients who had THA were improved after 12 months. One patient reported a worsened condition. All patients presented with good functional outcomes and normal radiological findings.
  
  
  CONCLUSIONS
  The indication for surgical intervention in patients with chronic low back pain and degenerative diseases must be critically assessed. THA in this cohort should focus on functional aspects, such as the improvement of range of motion, rather than the reduction of pain. Spine surgery in chronic low back pain patients after multidisciplinary pain program including cognitive - behavioral therapy cannot be recommended due to its questionable success.
authors.affiliation: Department of Orthopedic Surgery, University Hospital Leipzig, Liebigstrasse 20, Leipzig, 04103, Germany.
authors.forename: Nicolas H
authors.initials: NH
authors.lastname: von der Hoeh
authors.affiliation: Department of Orthopedic Surgery, University Hospital Leipzig, Liebigstrasse 20, Leipzig, 04103, Germany.
authors.forename: Anna
authors.initials: A
authors.lastname: Voelker
authors.affiliation: Department of Orthopedic Surgery, University Hospital Leipzig, Liebigstrasse 20, Leipzig, 04103, Germany.
authors.forename: Jens
authors.initials: J
authors.lastname: Gulow
authors.affiliation: Department of Psychology and Psychosomatic Medicine, University Hospital Leipzig, Semmelweissstr. 10, Leipzig, 04103, Germany.
authors.forename: Ute
authors.initials: U
authors.lastname: Uhle
authors.affiliation: Department of Anesthesiology, The University of Texas Medical Branch, 301 University Boulevard, Galveston, 77555, TX, USA.
authors.forename: Rene
authors.initials: R
authors.lastname: Przkora
authors.affiliation: Department of Orthopedic Surgery, University Hospital Leipzig, Liebigstrasse 20, Leipzig, 04103, Germany.
authors.forename: Christoph-Eckhard
authors.initials: CE
authors.lastname: Heyde
keywords: Chronic low back pain; Multidisciplinary pain program; Surgery; Total hip replacement