title: Interdisciplinary Cognitive-Behavioral Therapy as Part of Lumbar Spinal Fusion Surgery Rehabilitation: Experience of Patients With Chronic Low Back Pain.
abstract: BACKGROUND
  Patients receiving lumbar spinal fusion surgery often have persisting postoperative pain negatively affecting their daily life. These patients may be helped by interdisciplinary cognitive-behavioral therapy which is recognized as an effective intervention for improving beneficial pain coping behavior, thereby facilitating the rehabilitation process of patients with chronic pain.
  
  
  OBJECTIVE
  The purpose of this study was to describe the lived experience of patients recovering from lumbar spinal fusion surgery and to explore potential similarities and disparities in pain coping behavior between receivers and nonreceivers of interdisciplinary cognitive-behavioral group therapy.
  
  
  METHODS
  We conducted semistructured interviews with 10 patients; 5 receiving cognitive-behavioral therapy in connection with their lumbar spinal fusion surgery and 5 receiving usual care. We conducted a phenomenological analysis to reach our first aim and then conducted a comparative content analysis to reach our second aim.
  
  
  RESULTS
  Patients' postoperative experience was characterized by the need to adapt to the limitations imposed by back discomfort (coexisting with the back), need for recognition and support from others regarding their pain, a relatively long rehabilitation period during which they "awaited the result of surgery", and ambivalence toward analgesics. The patients in both groups had similar negative perception of analgesics and tended to abstain from them to avoid addiction. Coping behavior apparently differed among receivers and nonreceivers of interdisciplinary cognitive-behavioral group therapy. Receivers prevented or minimized pain by resting before pain onset, whereas nonreceivers awaited pain onset before resting.
  
  
  CONCLUSIONS
  The postoperative experience entailed ambivalence, causing uncertainty, worry and insecurity. This ambivalence was relieved when others recognized the patient's pain and offered support. Cognitive-behavioral therapy as part of rehabilitation may have encouraged beneficial pain coping behavior by altering patients' pain perception and coping behavior, thereby reducing adverse effects of pain.
authors.affiliation: Pil Lindgreen, MScN, RN, PhD student, The Research Program in Patient Involvement, Aarhus University Hospital, Aarhus, Denmark; and Centre for Child and Adolescent Psychiatry, Aarhus University Hospital, Aarhus, Denmark. Nanna Rolving, PhD, MHSc, PT, Research Physiotherapist, Diagnostic Centre, Regional Hospital Silkeborg, Silkeborg, Denmark. Claus Vinther Nielsen MD, PhD, Professor, Department of Public Health, Aarhus University, Aarhus, Denmark; and Centre for Public Health and Quality Improvement, Central Denmark Region, Aarhus, Denmark. Kirsten Lomborg, PhD, MScN, Professor, The Research Program in Patient Involvement, Aarhus University Hospital, Aarhus, Denmark; Department of Public Health, Aarhus University, Aarhus, Denmark; and Department of Clinical Medicine, Aarhus University, Aarhus, Denmark.
authors.forename: Pil
authors.initials: P
authors.lastname: Lindgreen
authors.forename: Nanna
authors.initials: N
authors.lastname: Rolving
authors.forename: Claus Vinther
authors.initials: CV
authors.lastname: Nielsen
authors.forename: Kirsten
authors.initials: K
authors.lastname: Lomborg
mesh_terms: D000223:Adaptation, Psychological; D000328:Adult; D002908:Chronic Disease; D015928:Cognitive Behavioral Therapy / Q000379:methods*; D005260:Female; D006801:Humans; D017116:Low Back Pain / Q000209:etiology / Q000523:psychology; D008159:Lumbar Vertebrae / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D010149:Postoperative Pain / Q000517:prevention & control / Q000523:psychology; D013123:Spinal Fusion / Q000534:rehabilitation*