A short, intensive cognitive behavioral pain management program reduces health-care use in patients with chronic low back pain: two-year follow-up results of a prospective cohort

Eur Spine J. 2012 Jul;21(7):1257-64. doi: 10.1007/s00586-011-2091-0. Epub 2011 Dec 3.


Purpose: Cognitive behavioral interventions are recommended as non-invasive treatment options for patients with chronic low back pain (CLBP). However, most treatment effects are small and short-lived. Although a 2-week intensive pain management program for patients with CLBP seems to be effective, the long-term results are not known. The purpose of this study is to evaluate the stability of the 2-year follow-up results and whether this is reflected in the use of health-care services.

Methods: A prospective cohort study was performed. Pre-treatment characteristics of patients and data of outcomes obtained at 1-year follow-up were used. At 2-year follow-up a structured interview was conducted following the principles of a post-marketing survey. Outcomes included daily functioning, quality of life, current intensity of pain, disturbance of pain during daily activities, and indicators of the use of pain medication and health-care services.

Results: Of the 90 eligible patients 85 (94%) participated in the post-marketing survey. The 1-year clinical relevant effects are maintained at 2-year follow-up. Effect sizes for functioning and quality of life were large. More than 65% reached preset minimal clinically important differences. At pre-treatment all patients consulted their general practitioner (GP) and medical specialist (MS). At 2-year follow-up 73% reported having consulted neither a GP nor an MS during the previous year. Most of the patients indicated not to use any pain medication (57%) and the percentage patients using opioids have decreased (14%). Moreover, 81% reported to be at work.

Conclusions: The gained results from selected and motivated patients with longstanding CLBP at 1-year follow-up are stable at 2-year follow-up. Above all, most of the participants are at work and results indicate that the use of both pain medication and health care have decreased substantially.

MeSH terms

  • Adult
  • Chronic Disease
  • Cognitive Behavioral Therapy / methods*
  • Cohort Studies
  • Delivery of Health Care / statistics & numerical data*
  • Disability Evaluation
  • Follow-Up Studies
  • Humans
  • Longitudinal Studies
  • Low Back Pain / psychology*
  • Low Back Pain / therapy*
  • Male
  • Middle Aged
  • Outcome Assessment, Health Care
  • Pain Management / methods*
  • Pain Measurement
  • Prospective Studies
  • Quality of Life / psychology
  • Treatment Outcome