Long-term results of an intensive cognitive behavioral pain management program for patients with chronic low back pain: a concise report of an extended cohort with a minimum of 5-year follow-up

European Spine Journal https://doi.org/10.1007/s00586-019-05967-6 ORIGINAL ARTICLE Long‑term results of an intensive cognitive behavioral pain management program for patients with chronic low back pain: a concise report of an extended cohort with a minimum of 5‑year follow‑up D. Groot1 · M. L. van Hooff2,3 · R. J. Kroeze1 · M. Monshouwer4 · J. O’Dowd5,6 · P. Horsting1 · M. Spruit1 Received: 22 October 2018 / Revised: 29 January 2019 / Accepted: 28 March 2019 © The Author(s) 2019 Abstract Purpose Treatment options for chronic low back pain (CLBP) include cognitive behavioral interventions. Most of these interventions only have small and short-lived effects. Using strict inclusion criteria for participation in an intensive combined physical and psychological program, encouraging effects were reported at 1-year follow-up. This study evaluates the longterm follow-up results of the same program. The hypothesis is that previously reported results are maintained. Methods Structured interviews were conducted in a prospective extended cohort with a minimum of 5-year follow-up in a similar fashion as in the 1-year follow-up report. The median follow-up in this cohort was 6.5 years. The extended cohort consisted of 277 patients (85% response). Results Outcomes include daily functioning, quality of life, current pain intensity, pain disturbance in daily activities and indicators of the use of pain medication and healthcare services. The previously reported positive 1-year follow-up results were maintained at a minimum of 5-year follow-up. Disability as measured with the Oswestry disability index (ODIv2.1a) decreased from 40 to 27 in the first year. This positive result was maintained at the 6.5-year follow-up with an ODI of 28. Pain intensity (NRS 0–100) improved from 60 to 39 in the first year, and at 6.5 years, this had further improved to 33. Improvement in quality of life (SF 36) at 1-year follow-up was maintained at 6.5-year follow-up, and healthcare consumption had decreased substantially as measured with doctor visits and analgesics used for CLBP. Conclusion Selected and motivated patients with longstanding CLBP improve fast after an intensive combined physical and psychological program in daily functioning, pain and quality of life. Positive 1-year results are maintained, and healthcare utilization was still reduced at a minimum of 5-year follow-up. Electronic supplementary material The online version of this article (https://doi.org/10.1007/s00586-019-05967-6) contains supplementary material, which is available to authorized users. Extended author information available on the last page of the article 13 Vol.:(0123456789) European Spine Journal Graphical abstract These slides can be retrieved under Electronic Supplementary Material. Key points Take Home Messages 1. Low back pain 1. A concise report of a previously reported one-year follow-up of extended cohort, now with a minimum 5 year follow-up. 2. Patients with CLBP improve fast after an intensive combined physical and psychological program in daily functioning, pain, and quality of life. 2. Cognitive therapy 3. Pain management 3. Positive one-year results are maintained and health care consumption was still reduced at a minimum of 5 years follow-up. Groot D, van Hooff ML, Kroeze RJ, Monshouwer M, O’Dowd J, Horsting P, Spruit M (2019) Long term results of an intensive cognitive behavioral pain management program for patients with chronic low back pain: A concise report of an extended cohort with a minimum 5 year follow-up. Eur Spine J; Groot D, van Hooff ML, Kroeze RJ, Monshouwer M, O’Dowd J, Horsting P, Spruit M (2019) Long term results of an intensive cognitive behavioral pain management program for patients with chronic low back pain: A concise report of an extended cohort with a minimum 5 year follow-up. Eur Spine J; Groot D, van Hooff ML, Kroeze RJ, Monshouwer M, O’Dowd J, Horsting P, Spruit M (2019) Long term results of an intensive cognitive behavioral pain management program for patients with chronic low back pain: A concise report of an extended cohort with a minimum 5 year follow-up. Eur Spine J; Keywords Low back pain · Cognitive therapy · Pain management Introduction Materials and methods Chronic low back pain (CLBP) is one of the major health and economic problems in Western countries with prevalence between 12 and 30%, and it is associated with persistent or recurrent disability, and societal costs remain very high. It is now the leading cause of disability worldwide [1–4]. In recent decades, several multidisciplinary pain management programs including programs based on cognitive behavioral principles have been developed to reduce disability caused by CLBP. Increasing evidence exists of the effectiveness of these programs in the short term up to two-year follow-up, but long-term results are not yet well known [5–8]. Although a recently published review of the literature showed that multidisciplinary biopsychosocial rehabilitation programs were more effective than usual care and physical treatments in decreasing disability and pain [9], conflicting evidence exists in treatment effects and possible cost reduction, with recently published research showing no benefit [10, 11]. Predictive factors for successful clinical outcome used in selecting CLBP patient for such a program have been determined, e.g., patients who are still in work and are mild to moderately disabled at the start of the program are most likely to benefit [12]. Using these predictive factors in patient selection for an extensive combined physical and psychological (CPP) program such as the program provided by RealHealthNL [13] may result in improved treatment outcomes and indirect cost reduction [7]. The purpose of the present study is to substantiate previously reported results and to report long-term results of the CPP program. The hypothesis is that previously reported results are maintained. Study design 13 The current cohort study is a concise long-term follow-up report of a previously published one-year follow-up study [14]. In this previous report, results of the CPP program as provided by R ealHealthNL® were presented. The program is an intensive two-week (total 100 h) hotel-based program, based on cognitive behavioral principles, and consists of education, physical training and cognitive behavioral training. It is compliant with the NICE guidelines for CLBP treatment [15]. The study protocol is approved by the hospital’s internal investigational review board. The medical ethical review committee of Slotervaart determined that ethical approval for this study was not required and exemption, as the Dutch Act on Medical Research involving Human Subjects does not apply to screening questionnaires that are part of routine clinical practice. All patients were informed about the procedure and had the opportunity to declare that (anonymized) data are not used for other purposes than scientific research. For this s (...truncated)