Purpose: The long term effects of treatment in a cohort of patients with chronic low back pain (CLBP) participating in an intensive pain management program.

Background: Cognitive behavioral treatments produce clinically relevant benefits for patients with CLBP.

Methods: The program provided by RealHealth-Netherlands is based on cognitive behavioral principles and executed in collaboration with orthopedic surgeons. Primary outcomes were daily functioning and self-efficacy. Measurements were at baseline, last day of residential program and at 1 and 12 months follow-up. A GLM procedure with repeated measures was applied to examine changes over time and to explore possible unwanted side effects. Effect sizes are analyzed using cohen’s d. Clinical relevance was examined using minimal clinical important differences (MCID) estimates for primary outcomes and quality of life. To compare results with literature Standardized Morbidity Ratios (SMR) were determined.

Results: 107 patients with CLBP participated. Mean scores on primary and secondary outcomes showed a similar pattern: improvement immediately after following the program and maintenance of results over time. Effect sizes were 0.9 for functioning and 0.8 for self-efficacy. Clinical relevancy: 79% reached MCID on functioning, 53% on self-efficacy and 80% on quality of life. Found study results were 36% better and 2% worse when related to previous research on respectively rehabilitation programs and spinal surgery for similar conditions (SMR 136% and 98%respectively).

Conclusion: The participants of this evidence based program learned to manage CLBP, improved in daily functioning and quality of life. The study results are comparable with results of spinal surgery and even better than results from less intensive rehabilitation programs.

Conflict of Interest: None

Sources of Funding: None

Education is now recognised as a crucial component of the management of non specific low back pain. Mostly education is carried out informally in one to one consultations with health professionals. This has draw backs as it is costly, time limited, labour intensive and biased towards the discipline, training and beliefs of the clinician. The Back Book is a realistic alternative but provides very generic neutral information mostly promoting the message that pain isn’t damage.

We would see the process as one of the facilitation of knowledge acquisition rather than a formal teaching process. The latter implies engagement and responsibility on the part of the learner, rather than a pedagogic exercise by clinician or therapist.

We propose a group based, community delivered, interdisciplinary education module in which 4 different specialists contribute to an afternoon information session aimed at informing patients about: the causes of back pain from a non disease perspective, the complexity of pain perception, the biopsychosocial model, evidence based treatment of pain and some principles of paced pain management. The focus is on dispelling myths (such as the need for MRI scanning, surgery etc.) and enabling sufferers to make improved decisions about their care.

Data from over 120 patient attendances will be presented. These indicate high acceptability and satisfaction with 92% rating the afternoon as good or excellent and only 11% claiming the session had not helped them make better decisions about future treatment.

This model is simple, relatively low cost and accessible to primary care, which is acceptable and seemingly helpful to sufferers. It appears to be a viable model for presenting information to back pain sufferers early in their illness. The aim of this is to help them make more informed decisions and to see the need to incorporate self management approaches early in their history. More data are needed to ascertain whether these are achievable goals.