Can treatment outcome of chronic low back pain be predicted? Psychological disease consequences clarifying the issue.

Abstract

To search for generalizable, psychological predictors of chronic pain treatment outcome. The prognostic power of the psychological predictors, classified into subareas of function, i.e., impairments, disabilities, and handicaps, was compared in predictive situations varying with the quality of patient samples, programs, and outcome measures. Four rehabilitation centers in Finland providing "functioning activation" or more passive "spa resort" treatment programs for low back pain patients. 173 low back pain patients for whom the inpatient rehabilitation program was funded by the Finnish Social Insurance Institution. The measures were panel assessment of global functioning (DSM III Axis V), self-report of handicap (Million), panel assessment of handicap (WHO index), panel assessment of adherence (four rating scales), and self-report of well-being (Faces scale). Multivariate, stepwise regression analyses suggested that the disability and handicap measures of functioning may be more effective predictors than impairment measures, which, however, add to the variance explained by the former. However, the predictive power of psychological impairments, disabilities, and handicaps varied with differences in patient group, outcome measure, and program. The "general predictors" of chronic pain treatment outcome may be difficult to find. Therefore, planning treatment for the individual patient may always have to be based on accurate multiaxial and multidimensional assessment of patient functioning.