Ioana Onac1, Daniel David2, Adela Moldovan2, Raluca Igna2, Rodica Ungur1, Ioan Onac1
*ungurmed@yahoo.com
1Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
2Babes-Bolyai University, Cluj-Napoca, Romania
Abstract
Low back pain is a very common cause of pain and disability. It creates significant costs from medical treatment and loss of work capacity. The current paper analyzed pain catastrophizing as a mechanism of change for pain intensity following multidisciplinary treatment of low back pain secondary to lumbar disc prolapse (for the primary effectiveness paper see Onac et al., 2012). We analyzed the outcome (pain intensity) in relationship with pain catastrophizing, for the three treatment groups involved in the clinical trial: medication alone (Med), medication and physio-kinetotherapy (Med-PhK) and medication, physio-kinetotherapy and cognitive-behavioral therapy (Med-PhK-CBT). Results showed reduced pain levels for patients in the multidisciplinary treatment groups as compared to medication alone and pain catastrophizing has a mediating role. Nonclinical catastrophizers (score for pain catastrophizing below 30) had better outcomes when offered physio-kinetotherapy (MD=1.632, p=.043) or physio-kinesiotherapy and CBT (MD=1.790, p=.042) compared to the medication alone. Clinical catastrophizers had significantly lowered pain levels compared to medication alone only when receiving both physio-kinesiotherapy and CBT (MD=-3.115, p=.007), physio-kinesiotherapy alone reducing pain levels similar to medication alone (non significant difference – MD=2.433, p=.053).
Results need to be confirmed on more patient samples, but they indicate that, for an effective and probably a cost-efficient treatment of low back pain, patients must be assessed for a psychological factor: pain catastrophizing. Those that have subclinical levels need medication and physio-kinesiotherapy to improve their pain. But if a patient is a clinical catastrophizer, CBT is essential to improve pain.
Keywords: low back pain, mechanisms of change, pain catastrophizing, cognitive-behavior therapy, low back pain treatment
Published online: 2017/09/01
Published print: 2017/09/01
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