Psychosocial interventions for low back pain in primary care: lessons learned from recent trials.

STUDY

DESIGN

Workshop discussion and literature overview.

OBJECTIVE

To give an overview of the main lessons learnt from recent trials on the effectiveness of psychosocial interventions for back pain in primary care.

SUMMARY OF BACKGROUND DATA: Recently, there has been a move to provide early psychosocial interventions in primary care to prevent chronic back pain. The results of most of the randomized trials, however, show only small differences between the psychosocial intervention and active control treatments in function or other outcome measures.

METHODS

During Low Back Pain Forum 2006 in Amsterdam 3 subgroups debated possible explanations for these "negative" findings, focusing on (1) patient selection, (2) the intervention, or (3) assessment. These discussions were illustrated with evidence from the literature and with data from 2 randomized trials.

RESULTS

The workshop participants highlighted the importance of better targeting psychosocial interventions at those who are at high risk of chronic back pain, and are likely to respond to treatment. Interventions should focus on modifiable prognostic factors, and address somatic, psychological, and social aspects of the pain problem. The general consensus was that, depending on the complexity of the condition, primary care providers can be involved in the psychosocial management of back pain, but should be adequately trained. Competencies of care providers and adherence to treatment protocols should be investigated in a process evaluation. Finally, although trials have included relevant instruments to measure back pain and disability, patient assessment might be improved by measuring other factors that may mediate or modify the effects of treatment.

CONCLUSION

Despite the publication of recent "negative" results of psychosocial interventions for back pain, workshop participants remained optimistic about the importance of this line of research. Suggestions are given for a refocused research agenda on the effectiveness of psychosocial interventions for back pain in primary care.