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Treatment for “Helpless” Women Suffering from Chronic Spinal Pain: A Randomized Controlled 18-Month Follow-Up Study

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Abstract

This prospective randomized controlled outcome study was designed to evaluate whether a MultiModal Cognitive—Behavioral Treatment for chronic spinal pain (MMCBT) specifically designed for women has an increased effect on well being and return to work compared to a regular MMCBT regimen. In Sweden, spinal pain is most prevalent among women. A tremendous amount of money is spent on secondary prevention of spinal pain. Yet, little is known about the effect of the interventions. A need for well designed outcome studies exist. Fifty-four subjects from a cohort of all registered sick-listed women in three districts of Stockholm participated in the study. Subjects were allocated by central randomization into two groups. One group was treated with a regular MMCBT program and the other group with a MMCBT program specifically designed for women. Assessments were performed at pretreatment–posttreatment (last treatment day) and at 6 and 18 months posttreatment. Questionnaires covering the bio-psycho-social spectra of the chronic pain syndrome, and sick leave were used to measure outcome. Intention to treat and true to protocol analyses were performed. The only significant differences found between groups were improvements in self-reported disability and in coping with pain, favoring the experimental treatment. About one-third of the variance in disability was explained by the set of pain-coping strategies assessed in the study. The results do not lend sufficient statistical support to warrant acceptance of the experimental treatment as superior to the regular treatment in improving health and sick leave. Further investigation with larger groups is needed before a solid scientific conclusion can be drawn.

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REFERENCES

  1. Swedish Trade Union Confederation. Disability pension and work environment, Vol. 4 (Förtids pensionering och arbetsmiljö). Stockholm, 1994.

  2. National Health Insurance Authority. The social insurances, Fiscal year 1993/94 (Socialförsakringen. Årsredovsining 1993/94). Stockholm, 1995.

  3. National Health Insurance Authority. The social insurances. Fiscal year 1994/95 (Socialförsaklringen. Årsredovisning 1994/95). Stockholm, 1996.

  4. Spitzer WO, LeBlanc FE, Dupuis M. Scientific approach to the assessment and management of activity-related spinal disorders. Spine 1987 (Suppl.): 7S.

    Google Scholar 

  5. Nachemson A. Back pain (Ont i ryggen). The Swedish Council on Technology Assessment in Health Care. Stockholm, 1991.

    Google Scholar 

  6. Van Tulder M. Diagnostics and treatment of chronic low back pain in primary care. EMGO institute, Vrije University, Amsterdam: 1996.

    Google Scholar 

  7. Flor H, Fydrich T, Turk DC. Efficacy of multidisciplinary pain treatment centres: A metaanalytic review. Pain 1992; 49: 221–230.

    Google Scholar 

  8. Turner JA. Educational and behavioral interventions for back pain in primary care. Spine 1996; 21: 2851–2857.

    Google Scholar 

  9. Toomey TC, Taylor AG, Carron H. et al. Five-year follow-up status of patients originally treated with nerve blocks for low-back pain. Pain 1982; 12: 273–283.

    Google Scholar 

  10. Jensen I. Nonspecific Spinal Pain: Multidisciplinary Intervention, a Cognitive—Behavioral Approach Department of Orthopaedics, and Section of Personal Injury Prevention, Department of Otorhinolaryngology, Karolinska Institute, Stockholm, 1993, p. 119.

    Google Scholar 

  11. Lindström I, Öhlund C, Eek C, et al. The effect of graded activity on patients with subacute low back pain: A randomized prospective clinical study with an operant conditioning behavioral approach. Phys Ther 1992; 72: 279–293.

    Google Scholar 

  12. Manniche C, Lundberg E, Christensen I. Intensive dynamic back exercises for chronic low back pain: A clinical trial. Pain 1991; 47: 53–63.

    Google Scholar 

  13. Rosenstiel AK, Keefe FJ. The use of coping strategies in chronic low back pain patients: Relationship to patient characteristics and current adjustment. Pain 1983; 17: 33–44.

    Google Scholar 

  14. Buckelew S, Shutty M, Hewett J, et al. Health locus of control, gender differences and adjustment to persistent pain. Pain 1990; 42: 287–294.

    Google Scholar 

  15. Estlander AM. Coping strategies in low back pain: Effects of severity of pain, gender and duration of pain. Scand J Behav Ther 1989; 18: 20–29.

    Google Scholar 

  16. Estlander AM, Härkäpää K. Relationships between coping strategies, disability and pain levels in patients with chronic pain. Scand J Behav Ther 1989; 18: 59–69.

    Google Scholar 

  17. Geisser ME, Robinson ME, Henson CD. The Coping Strategies Questionnaire and Chronic Pain Adjustment: A conceptual and empirical re-analysis. Clin J Pain 1994; 10: 98–196.

    Google Scholar 

  18. Jensen MP. Turner JA, Romano JM. Self-efficacy and outcome expectancies: Relationship to chronic pain coping strategies and adjustment. Pain 1991; 44: 263–269.

    Google Scholar 

  19. Jensen MP, Turner JA, Romano JM, et al. Coping with chronic pain: a critical review of the literature. Pain 1991; 47: 249–283.

    Google Scholar 

  20. Keefe FJ, Brown GK, Wallston KA, et al. Coping with rheumatoid arthritis pain: Catastrophizing as a maladaptive strategy. Pain 1989; 37: 51–56.

    Google Scholar 

  21. Keefe FJ, Crisson J, Urban BJ, et al. Analyzing chronic low back pain: The relative contribution of pain coping strategies. Pain 1990; 40: 293–301.

    Google Scholar 

  22. Turk DC, Okifuji A, Scharff L. Chronic pain and depression: Role of perceived impact and perceived control in different age cohorts. Pain 1995; 61: 93–101.

    Google Scholar 

  23. Jensen IB, Nygren Å, Lundin A. Cognitive-behavioral treatment for workers with chronic spinal pain: A matched and controlled cohort study in Sweden. Occup Environ Med 1994; 51: 145–151.

    Google Scholar 

  24. Jensen I, Nygren Å, Gamberale F, et al. Coping with long-term musculoskeletal pain and its consequences: Is gender a factor? Pain 1994; 57: 167–172.

    Google Scholar 

  25. Jensen IB, Nygren, Å, Gamberale F, et al. The Psychologists Role in Multidisciplinary Treatments for Chronic Neck and Shoulder Pain: A controlled cost-effectiveness study. Scand J Rehab Med 1995; 27: 19–26.

    Google Scholar 

  26. Callahan LF, Brooks RH, Pincus T. Further analysis of learned helplessness in rheumatoid arthritis using a “rheumatology attitudes index.” J Rheumatol 1988; 15: 418–425.

    Google Scholar 

  27. Huskisson EC. Measurement of pain. Lancet 1974; 9: 1127–1131.

    Google Scholar 

  28. Beck AT, Ward CH, Mendelson M, et al. An inventory for measuring depression. Arch Gen Psych 1961; 4: 561–571.

    Google Scholar 

  29. Nicassio PM, Wallston KA, Callahan LF, et al. The measurement of helplessness in rheumatoid arthritis. The development of the Arthritis Helplessness Index. J Rheumatol 1985; 12; 462–467.

    Google Scholar 

  30. Jensen IB, Bergstrom KG, Nygren, ÅL, et al. A gender differentiated evaluation of the Swedish version of the Rheumatology Attitudes Index (RAI). Scand J Behav Ther 1997; 26: 36–45.

    Google Scholar 

  31. Jensen IB, Linton SJ. Coping Strategies Questionnaire (CSQ): Reliability of the Swedish version of the CSQ. Scand Behav Ther 1993; 22: 139–145.

    Google Scholar 

  32. Salén BA, Spangfort EV, Nygren ÅL, et al. The global self-rating index. A measure of health related quality of life in locomotor disorders. Submitted

  33. Salén BA, Spangfort EV, Nygren, ÅL, et al. The Disability Rating Index: An instrument for the assessment of disability in clinical settings. J Clin Epidemiol 1994; 47: 1423–1434.

    Google Scholar 

  34. Linton SJ, Bradley LA, Jensen I, et al. The secondary prevention of low back pain: A controlled study with follow-up. Pain 1989; 36: 197–207.

    Google Scholar 

  35. Nygren Å. Åre neck study. Rehabilitation of patients with pain in neck and shoulder (Åre Projektet. Rehabilitering av patienter med smärttillstånd i nacke/skuldra). Folksam, Stockholm, 1992.

    Google Scholar 

  36. Turk DC, Rudy TE. Neglected factors in chronic pain treatment outcome studies—Referral patterns, failure to enter treatment, and attrition. Pain 1990; 43: 7–25.

    Google Scholar 

  37. Debrunner HV. Das kyphometer. Z Orlhop Ihre Grenzgebiete 1972; 110: 389–392.

    Google Scholar 

  38. American Academy of Orthopaedic Surgeons. Joint motion. Method of measuring and recording. Edinburgh: Churchill Livingstone, Edinburgh, 1966.

    Google Scholar 

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Authors and Affiliations

  1. Karolinska Institute, Stockholm, Sweden

    Irene B. Jensen & Åke Nygren

  2. Åre Rehabilitation Centre, Åre, Sweden

    Catarina Dahlquist

  3. National Health Insurance Authority, Stockholm, Sweden

    Eva Royen & Monica Stenberg

Authors
  1. Irene B. Jensen
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  2. Catarina Dahlquist
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  3. Åke Nygren
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  4. Eva Royen
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  5. Monica Stenberg
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Correspondence to Irene B. Jensen.

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Jensen, I.B., Dahlquist, C., Nygren, Å. et al. Treatment for “Helpless” Women Suffering from Chronic Spinal Pain: A Randomized Controlled 18-Month Follow-Up Study. J Occup Rehabil 7, 225–238 (1997). https://doi.org/10.1023/B:JOOR.0000010858.70743.21

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  • DOI: https://doi.org/10.1023/B:JOOR.0000010858.70743.21

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