Affiliations: [a] Research Group Psychosomatic Rehabilitation, Charité University Medicine, Berlin, Germany | [b] Department of Psychosomatic and Orthopedic Rehabilitation, Rehabilitation Center of the German Federal Pension Agency, Frankenhausen, Germany
Correspondence:
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Corresponding author: M. Linden, Research Group Psychosomatic Rehabilitation, Lichterfelder Allee 55, 14513 Teltow, Germany. Tel.: +49 03328/345678; Fax: +49 03328/345555; E-mail: michael.linden@charite.de
Abstract: Background:It is empirically well documented that psychotherapy is vital in the treatment of chronic back pain. Objective:To test in this randomized controlled clinical trial whether cognitive behavior group therapy is effective in respect to pain tolerance and disability apart from the effects on somatization in general and additional to the effects of a multimodal inpatient orthopedic rehabilitation programme. Methods:Fifty-three patients were randomly assigned to an intervention group, receiving six sessions of “cognitive behavior group therapy for back pain” (CBT-BP), and 50 to a control group who got unspecific occupational therapy sessions instead. Patients were suffering from chronic back pain for at least six months. All patients were treated for 21 days in an orthopedic inpatient rehabilitation unit with a multimodal orthopedic treatment, including active physical therapy, patient education or motivation to exercise. Results:In both groups there is a significant improvement over time in the Symptom Checklist (SCL-90), the Rating of Health Locus of Control Attributions, the Fear Avoidance Beliefs Questionnaire (FABQS) and a Visual Analogue Pain Scale (VAS-pain). There are significant interactions between treatment group and VAS-pain and the FABQS, showing a superior improvement in the intervention group, while no significant superiority is found for the SCL. Conclusions:The experience of pain can be altered directly and not only through improvement of depression or general somatoform complaints. The study replicates other research and increases the evidence base for this mode of treatment. The treatment effect can be called specific as it is found additional to a multimodal inpatient care programme.
Keywords: Cognitive behavior therapy, low back pain, rehabilitation, fear avoidance beliefs, pain, locus of control
