Preventing Progression to Chronicity in First Onset, Subacute Low Back Pain: An Exploratory Study

Abstract

Slater MA, Weickgenant AL, Greenberg MA, Wahlgren DR, Williams RA, Carter C, Patterson TL, Grant I, Garfin SR, Webster JS, Atkinson JH. Preventing progression to chronicity in first onset, subacute low back pain: an exploratory study. Objectives To evaluate the effects of a behavioral medicine intervention, relative to an attention control, in preventing chronic pain and disability in patients with first-onset, subacute low back pain (LBP) with limitations in work-role function. Design A 2-group, experimental design with randomization to behavioral medicine or attention control groups. Setting Orthopedic clinic at a Naval Medical Center. Participants Sixty-seven participants with first-onset LBP of 6 to 10 weeks of duration and impairment in work function, of whom 50 completed all 4 therapy sessions and follow-up 6 months after pain onset. Intervention Four 1-hour individual treatment sessions of either behavioral medicine, focused on back function and pain education, self-management training, graded activity increases, fear reduction, and pain belief change; or attention control condition, focused on empathy, support, and reassurance. Main Outcome Measures The primary outcome was proportion of participants classified as recovered, according to pre-established clinical cutoffs on standardized measures, signifying absence of chronic pain and disability at 6 months after pain onset. Secondary analyses were conducted on pain, disability, health status, and functional work category. Intervention credibility and pain belief manipulation checks were also evaluated. Results Chi square analyses comparing proportions recovered at 6 months after pain onset for behavioral medicine and attention control participants found relative rates of 52% versus 31% in the modified intent-to-treat sample ( P=.09) and 54% versus 23% for those completing all 4 sessions and 6-month follow-up ( P=.02). At 12 months, 79% of recovered and 68% of chronic pain participants still met criteria for their respective groups ( P<.0001). Recovered participants also had higher rates of functional work status recovery at 12 months (recovered: 96% full duty and 4% light duty; chronic pain: 61% full duty, 18% light duty, and 21% medical discharge, respectively; P=.03). Conclusions Early intervention using a behavioral medicine rehabilitation approach may enhance recovery and reduce chronic pain and disability in patients with first-onset, subacute LBP. Effects are stronger for participants attending all 4 sessions and the follow-up assessment.