Cognitive-Behavioural Treatment of Chronic Pain in Primary Care

Abstract

Objectives: To analyse the frequencies of, and the clinical risk factors for, full-time sick leave (100% sick leave) in the past month after cognitive-behavioural treatment of young persons at risk of permanent disability.Patients and methods: Persons aged 16-45 years on more than six weeks of sick leave for benign disorders were asked to participate in a four-week treatment programme in primary care. It included weekly patient-doctor dialogues on worries about pain, and daily training. Mental and somatic health and psychosocial stressors were assessed. Locations of muscular insertion lesions (enthesopathies) were counted. Pain behaviour was defined as ≥1.5 points on the University of Alabama scale. Self-reported inability to work, pain anxiety, pain behaviour and depression were evaluated before and after the treatment.All variables were categorised. Non-parametric tests were used to detect group differences and changes in related dichotomous variables. The variables that were significantly related to 100% sick leave at the three-month, one-year and three-year follow-ups were used as independent variables in multinomial logistic regression calculations of odds ratios (ORs) with 95% confidence intervals (95% CI) for 100% sick leave in the past month. Also, three or more enthesopathy locations and previous 100% sick leave of more than three months were chosen as independent variables. The ORs were adjusted for age and sex.Results: Two Swedes and 149 immigrants participated; nearly all were working in the service sector. Long periods of sick leave were common, on average 47 weeks. All reported pain as their major problem, mostly in the back and shoulders, and 27.8% had three or more locations of enthesopathies. Pain anxiety (76% to 50%), self-reported inability to work (75% to 60%) and pain behaviour (68% to 54%) were common but diminished after treatment (p<0.001). The frequency of 100% sick leave in the past month decreased at the follow-ups, from 76% at the start to 48%, 44% and 51%, respectively (p<0.001). Persons with self-reported inability to work had ORs of 3.04 (95% CI 1.22-7.56) at the three-month follow-up, and 3.13 after one year (95% CI 1.26-7.80) for being on 100% sick leave, while persons with three or more enthesopathy locations had an OR of 2.98 (95% CI 1.19-7.44) after three years. Previous durations of 100% sick leave of more than three months had significant ORs varying from 5.19 to 2.89.Conclusion: The number of persons on 100% sick leave declined significantly after this treatment. The risk factors for future 100% sick leave were, in the short term, self-reported inability to work and, in the long term, multiple enthesopathies.