Abstract

BACKGROUND:

Psychological factors influence the development and persistence of chronic low back pain (CLBP) and may impair the psychosocial rehabilitation success.

OBJECTIVE:

To examine the effects of a combined pain competence and depression prevention training compared to the pain competence training alone and as well as the patients’ stages of pain on the long-term psychosocial rehabilitation success.

METHODS:

In this controlled multicentre study with cluster-block randomization, patients with CLBP in different stages of pain (I–III) received either pain competence training (control group, CG; n= 255) or combined pain competence and depression prevention training (intervention group, IG; n= 271; per protocol). Depressive symptoms (primary outcome), anxiety, somatization, health status, and average pain intensity (secondary outcomes) were assessed up to 12 months of follow-up. Standardised questionnaires were used to record the outcomes, which were filled out by the patients themselves. Analyses after multiple imputation (N= 1225) were conducted to validate multi- and univariate analyses of variance.

RESULTS:

Patients in stage of pain I and II showed significant improvements in depressive symptoms, anxiety, mental health, and average pain intensity at the 12-month follow-up, irrespective from treatment condition.

CONCLUSIONS:

Multidisciplinary rehabilitation seems to be appropriate for patients with CLBP in stage of pain I and II. However, patients in stage of pain III need more psychological treatments to manage their mental comorbidities.

中文翻译：

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慢性腰痛患者康复治疗及预防疼痛进一步慢性化的远期疗效

摘要

背景：

心理因素影响慢性腰痛 (CLBP) 的发展和持续，并可能影响社会心理康复的成功。

客观的：

与单独的疼痛能力训练相比，检查疼痛能力和抑郁症预防联合训练的效果，以及患者的疼痛阶段对长期社会心理康复成功的影响。

方法：

在这项采用整群随机分组的多中心对照研究中，处于不同疼痛阶段（I-III）的 CLBP 患者接受了疼痛能力训练（对照组，CG；n=255）或结合疼痛能力和抑郁症预防训练（干预组，IG；n=271；根据协议）。在长达 12 个月的随访期间，对抑郁症状（主要结果）、焦虑、躯体化、健康状况和平均疼痛强度（次要结果）进行了评估。使用标准化问卷记录结果，由患者自己填写。多重插补后分析（否=1225）进行验证多变量和单变量方差分析。

结果：

疼痛 I 期和 II 期患者在 12 个月的随访中表现出抑郁症状、焦虑、心理健康和平均疼痛强度的显着改善，无论治疗条件如何。

结论：

多学科康复似乎适用于疼痛 I 期和 II 期的 CLBP 患者。然而，处于疼痛III期的患者需要更多的心理治疗来控制他们的精神合并症。