title: Study protocol - efficacy of an attachment-based working alliance in the multimodal pain treatment.
abstract: BACKGROUND
  The concept of attachment is relevant for the onset and development of chronic pain. Insecure attachment styles negatively affect therapeutic outcome. Insecurely attached patients seem to be less able to sustain positive effects of a multimodal treatment program. However, it has never been tested before if an attachment-oriented approach can improve treatment results of insecurely attached patients in a multimodal outpatient setting. To test this assumption, we compare the short- and long-term outcomes for pain patients who will receive multidisciplinary, attachment-oriented treatment with the outcomes for patients in a control group, who will receive the multidisciplinary state-of-the-art treatment.
  
  
  METHODS
  Two patient groups (baseline, attachment intervention) are assessed before treatment, after treatment, and at a 6 month follow-up. The study is conducted in a block design: After data collection of the first block (controls) and before as well as during data collection for the second block (treatment group), the health care personnel of the outpatient pain clinic receives training on attachment theory and its use in the therapeutic context. Pain intensity as measured with visual analogue scales and physical functioning will serve as the primary outcome measures.
  
  
  CONCLUSIONS
  The design of our study allows for a continuous exchange of experienced team members, which may help bring about concrete attachment related guidelines for the enhancement of therapeutic outcome. This would be the first attempt at an attachment-oriented improvement of multimodal pain programs.
  
  
  CONCLUSIONS
  An attachment-based approach may be a promising way to enhance long-term treatment outcomes for insecurely attached pain patients.
  
  
  BACKGROUND
  DRKS00008715 (registered on the 3(rd) of June 2015).
authors.affiliation: Center for Orthopedics, Trauma Surgery and Spinal Cord Injury, Heidelberg University Hospital, Schlierbacher Landstr 200a, 69118, Heidelberg, Germany. ann-christin.pfeifer@med.uni-heidelberg.de.|Department of Orthopedics, Outpatient Multidisciplinary Pain Clinic, Trauma Surgery and Paraplegiology, Heidelberg University Hospital, Schlierbacher Landstr. 200a, 69118, Heidelberg, Germany. ann-christin.pfeifer@med.uni-heidelberg.de.
authors.forename: Ann-Christin
authors.initials: AC
authors.lastname: Pfeifer
authors.affiliation: University of Heidelberg, Grabengasse 1, 69117, Heidelberg, Germany.
authors.forename: Dorothee
authors.initials: D
authors.lastname: Amelung
authors.affiliation: Center for Orthopedics, Trauma Surgery and Spinal Cord Injury, Heidelberg University Hospital, Schlierbacher Landstr 200a, 69118, Heidelberg, Germany.
authors.forename: Carina
authors.initials: C
authors.lastname: Gerigk
authors.affiliation: Center for Orthopedics, Trauma Surgery and Spinal Cord Injury, Heidelberg University Hospital, Schlierbacher Landstr 200a, 69118, Heidelberg, Germany.
authors.forename: Corinna
authors.initials: C
authors.lastname: Schroeter
authors.affiliation: Department of General Internal Medicine and Psychosomatics, Heidelberg University Hospital, Thibautstr 2, 69115, Heidelberg, Germany.
authors.forename: Johannes
authors.initials: J
authors.lastname: Ehrenthal
authors.affiliation: Center for Orthopedics, Trauma Surgery and Spinal Cord Injury, Heidelberg University Hospital, Schlierbacher Landstr 200a, 69118, Heidelberg, Germany.
authors.forename: Eva
authors.initials: E
authors.lastname: Neubauer
authors.affiliation: Center for Orthopedics, Trauma Surgery and Spinal Cord Injury, Heidelberg University Hospital, Schlierbacher Landstr 200a, 69118, Heidelberg, Germany.
authors.forename: Marcus
authors.initials: M
authors.lastname: Schiltenwolf
mesh_terms: D000328:Adult; D000368:Aged; D059350:Chronic Pain / Q000523:psychology / Q000628:therapy*; D002985:Clinical Protocols; D003131:Combined Modality Therapy; D006801:Humans; D008875:Middle Aged; D009769:Object Attachment; D059408:Pain Management / Q000379:methods* / Q000523:psychology; D010348:Patient Care Team; D011581:Psychological Tests