Brief intervention, physical exercise and cognitive behavioural group therapy for patients with chronic low back pain (The CINS trial)

A Harris; T F Moe; H R Eriksen; T Tangen; S A Lie; T H Tveito; S E Reme

doi:10.1002/ejp.1041

Brief intervention, physical exercise and cognitive behavioural group therapy for patients with chronic low back pain (The CINS trial)

Eur J Pain. 2017 Sep;21(8):1397-1407. doi: 10.1002/ejp.1041. Epub 2017 Apr 27.

Authors

A Harris¹, T F Moe², H R Eriksen^{3

4}, T Tangen⁵, S A Lie^{3

6}, T H Tveito^{3

7}, S E Reme^{3

8

9}

Affiliations

¹ Department of Psychosocial Science, Faculty of Psychology, University of Bergen, Norway.
² Oslo University Hospital, Norway.
³ Uni Research Health, Bergen, Norway.
⁴ Department of Sport and Physical Activity, Bergen University College, Norway.
⁵ Department of Clinical Medicine, Section of Psychiatry, Haukeland University Hospital, Bergen, Norway.
⁶ Department of Clinical Dentistry, University of Bergen, Norway.
⁷ Department of Health Promotion, University College of Southeast Norway, Horten, Norway.
⁸ Department of Pain Management and Research, Oslo University Hospital, Norway.
⁹ Department of Psychology, Faculty of Social Sciences, University of Oslo, Norway.

PMID: 28449303
DOI: 10.1002/ejp.1041

Abstract

Background and objective: Cognitive-behavioural treatments (CBT) and physical group exercise (PE) have both shown promising effects in reducing disability and increasing work participation among chronic low back pain (CLBP) patients. A brief cognitive intervention (BI) has previously been demonstrated to reduce work disability in CLBP. The aim of this study was to test if the effect of BI could be further increased by adding either group CBT or group PE.

Methods: A total of 214 patients, all sick listed 2-10 months due to CLBP, were randomized to BI (n = 99), BI + group CBT (n = 55) or BI + group PE (n = 60). Primary outcome was increased work participation at 12 months, whereas secondary outcomes included pain-related disability, subjective health complaints, anxiety, depression, coping and fear avoidance.

Results: There were no significant differences between the groups in work participation at 12 months follow-up (χ² = 1.15, p = 0.56). No significant differences were found on the secondary outcomes either, except for a statistically significant reduction (time by group) in pseudoneurology one domain of subjective health complaints (sleep problems, tiredness, dizziness, anxiety, depression, palpitation, heat flushes) (F_2,136 = 3.109, p = 0.048) and anxiety (F_2,143 = 4.899, p = 0.009) for the groups BI + group CBT and BI + group PE, compared to BI alone. However, these differences were not significant in post hoc analyses (Scheffé adjusted).

Conclusion: There was no support for an effect of the added group CBT or group PE treatments to a brief cognitive intervention in this study of patients on sick leave due to low back pain.

Significance: Our study demonstrates that treatments that previously were found to be effective and are included in most treatment guidelines, such as group cognitive-behavior therapy and exercise, were not effective in this given context compared to a brief, cognitive intervention. This implies that an optimized brief intervention is difficult to outperform in patients on sick leave due to low back pain.

Publication types

Multicenter Study
Randomized Controlled Trial

MeSH terms

Adaptation, Psychological
Adult
Chronic Pain / therapy*
Cognitive Behavioral Therapy*
Disability Evaluation
Exercise Therapy*
Female
Humans
Low Back Pain / therapy*
Male
Middle Aged
Psychotherapy, Brief*
Psychotherapy, Group*
Sick Leave
Treatment Outcome