Risk Factor-Based Cognitive- Behavioural Therapy for Acute and Subacute Back Pain
Monika I. Hasenbring, Bernhard W. Klasen, and Adina C. Rusu
There is substantial evidence that treatment of patients with chronic back pain reveals limited success. Although several multimodal approaches including pharmacological, physiotherapeuti- cal, and psychological features lead to statistical significant reduction of pain, pain-related disability, and work absenteeism, effect sizes are only small to moderate. Effects concerning clinical significance are rather marginal (Van der Windt et al. 2008). A number of systematic reviews concluded that offering patients multimodal treatment only when pain and disability had evolved into a chronic state and offering treatment in the same manner to each patient represent two of the central problems in treatment allocation (Morley et al. 1999; van Tulder et al. 2001; Hoffmann et al. 2007; Henschke et al. 2010). Turner and colleagues (1996) recommended the implementation of early educational and cognitive-behavioural interventions in the phase of subacute pain, when patients are still in primary care as well as more interventions targeted to the individual needs of the patients. Treating low back pain (LBP) patients not as a homogeneous group and identifying specifiable subgroups due to clinical, psychological, neurophysiological, and perhaps genetic risk variables represents an important topic for research (Turk 2005; Brennan et al. 2006; see Chapter 26). In line with this, Haldorsen (2003) pointed out that there is a challenge to find ‘the right treatment to the right patient at the right time’.
In this chapter, we will present some basic considerations concerning: (1) the choice of an ‘optimal’ time point, starting with more comprehensive, multimodal treatment approaches at a cost-effective level; (2) potential criteria defining features of patients with back pain that may describe appropriate patients; and (3) finding the right treatment for a specific patient. A qualitative review of empirical evidence improving efficacy and effectiveness of current attempts in early, risk factor-based psychosocial interventions in the treatment of subacute back pain will follow. In the third section of this chapter, we will provide an illustrative description of current treatment options. Finally, we will try to draw some conclusions towards the need for future research and clinical practice.