Jensen, 2001

Sweden

Duration of pain: 31 months

RCT

Fair

A. Comprehensive pain management program, (n=63): 4 weeks (33-34 hours/week, plus six 90-minute booster sessions over a period of 1 year after treatment); high intensity, group; Rehabilitation clinic

B. Psychological Therapy (n=49): 4 weeks, (13-14 hours/week, plus six 90-minute booster sessions over a period of 1 year after treatment); low intensity, group in person; Rehabilitation clinic

Mean age: 43 years

Male: 45%

Race/ethnicity: Swedish origin 67%

Pain etiology/type: Chronic nonspecific spinal pain

-

Cervical/thoracic pain: 42%

-

Lumbar pain: 46%

-

Mixed pain areas: 12%

-

Mean total sick leave in 6 months prior to inclusion in study: 292 (63)

-

NR

A vs. B, Mean (SD)

SF-36 Global health (0-100)

Females only (n=30 vs. 22)

Baseline: 38.1 (14.5) vs. 38.9 (13.7)

Postintervention: 47.6 (18.0) vs. 48.8 (16.8)

Intermediate term: 52.4 (21.6) vs. 54.2 (19.3)

Long term: 53.1 (24.5) vs. 58.2 (18.4)

-

improvement approached significance for group B at Long term(p=0.057)

Males only (n=33 vs. 27)

Baseline: 41.6 (14.6) vs. 43.8 (16.0)

Postintervention: 48.5 (17.2) vs. 44.8 (18.0)

Intermediate term: 54.3 (18.3) vs. 43.5 (19.1))

Long term: 57.2 (21.8) vs. 50.8 (27.9)

-

Nonsignificant group effect via MANCOVA with a repeated-measures design

-

p=ns between interventions at any timepoint

A vs. B, Mean (SD)

Harms: NR

Perceived appropriateness of the treatment program to treating patient’s pain (0-10)

Females only (n=30 vs. 22)

Postintervention: 6.4 (3.1) vs. 4.8 (3.7), p=ns

Males only (n=33 vs. 27)

Postintervention: 6.0 (3.6) vs. 4.5 (3.2), p=ns

Likelihood of recommending treatment program to a relative with a similar pain condition (0-10)

Females only (n=30 vs. 22)

Postintervention: 7.0 (3.7) vs. 6.0 (3.8), p=ns

Males only (n=33 vs. 27) A vs. B

Postintervention: 6.1 (4.3) vs. 5.1 (4.2), p=ns

Linton, 2005

Sweden

Pain duration: NR (>12 weeks: 84%)

RCT

Fair

A. Comprehensive pain management program, (n=69): 6 weeks (hours not reported, at least 12 total); low intensity, group; Primary care (outpatient)

B. Psychological Therapy (n=47): 6 weeks, (2 hour session); low intensity, group; outpatient

Mean age: 48 years

Male: 16%

Race/ethnicity: NR

Pain etiology/type:

-

Chronic back pain: 90%

-

Chronic neck pain: 10%

Comorbidities: NR

A vs. B, Mean (SD)

Pain Numeric Rating Scale (0-10)

Average pain last week:

Baseline: 4.4 (2.1) vs. 4.2 (2.5)

Long term: 2.9 (2.2) vs. 3.4 (2.4); difference −0.5 (95% CI −1.35 to 0.35)

Average pain last 3 months:

Baseline: 4.5 (1.9) vs. 4.5 (2.1)

Long term: 3.0 (1.8) vs. 3.2 (2.4); difference −0.2 (95% CI −0.98 to 0.58)

Worst pain last 3 months:

Baseline: 6.0 (2.3) vs. 5.6 (2.5)

Long term: 4.3 (2.9) vs. 4.5 (3); difference −0.2 (95% CI −1.29 to 0.89)

Pain-free days in last week (0-7)

Baseline: 2.3 (2.5) vs. 1.9 (3.0)

Long term: 3.5 (3.0) vs. 3.2 (3); difference 0.3 (95% CI −0.81 to 1.41)

Activities of Daily Living (0-50)

Baseline: 38.9 (10.0) vs. 38.9 (12.3)

Long term: 41.5 (10.4) vs. 42.6 (7.9); difference −1.10 (95% CI – 4.55 to 2.35)

RMDQ (0-18)

Baseline: 3.7 (4.5) vs. 3.4 (5.1)

Long term: 3.4 (4.2) vs. 3.2 (4.1); difference 0.2 (95% CI −1.33 to 1.74)

A vs. B, Mean (SD)

HADS Anxiety (0-21)

Baseline: 4.9 (3.8) vs. 5.3 (5.1)

Long term: 5.2 (3.6) vs. 5.1 (4.3); difference 0.10 (95% CI −1.36 to 1.56)

HADS Depression (0-21)

Baseline: 3.8 (1.27) vs. 4.1 (4.0)

Long term: 3.8 (3.6) vs. 4.0 (4.5): difference −0.20 (95% CI −1.70 to 1.30)

A vs. B, Mean (SD)

Number of health care visits for spinal pain during the past year

12 months before treatment: 2 vs. 1.5

Long term: 1.25 vs. 2.5, p=0.06

Smeets, 2006a, 2008

Netherlands

Pain duration: 56.7 months

RCT

Fair

A. Comprehensive pain management program (n=61): 10 weeks (79 hours total), low intensity, group and individual, outdoor rehabilitation centers

B. Psychological Therapy only (CBT) only (n=58): 10 weeks (26.5 hours total), low intensity, group and individual, rehabilitation center

Mean age: 42 years

Male: 53%

Race/ethnicity: NR

Pain etiology/type: Pain etiology/type: LBP

-

radiation of pain below knee: 49%

-

radiation of pain above knee: 37%

-

without radiation of pain: 14%

Disability:

Full sick leave/disability pension: 38%

Partial sick leave/disability pension: 24%

Comorbidities: NR

A vs. B, adjusted mean change score (SD) from baseline

VAS, current pain (0-10)

Baseline: 4.598 (2.395) vs. 4.884 (2.351)

Postintervention: −0.490 (–1.132 to 0.152) vs. −1.025 (–1.669 to – 0.381); adjusted difference in change scores 0.535 (95% CI −0.373 to 1.442)

Intermediate term: A 0.217 (–0.435 to 0.870) vs. – 0.408 (–1.056 to 0.241); adjusted difference in change scores 0.625 (95% CI −0.294 to 1.544)

Long term: 0.573 (–0.079 to 1.225) vs. −0.315 (–0.971 to 0.341); adjusted difference in change scores 0.888 (95% CI −0.036 to 1.813)

VAS, main (activity) complaints (0-10)

Baseline: 7.244 (1.703) vs. 7.471 (1.619)

Postintervention: −1.748 (–2.418 to −1.078) vs. −1.574 (–2.251 to – 0.898); adjusted difference in change scores −0.174 (95% CI −1.123 to 0.775)

Intermediate term: −1.285 (–1.962 to −0.608) vs. −1.767 (–2.444 to – 1.090); adjusted difference in changes scores 0.482 (95% CI −0.474 to 1.438)

Long term: −1.195 (–1.874 to – 0.515) vs. −2.019 (–2.705 vs. – 1.332); adjusted difference in change scores 0.824 (95% CI – 0.140 to 1.788)

MPQ Pain Rating Index Total score (PRI-T) (scale NR)

Baseline: 18.08 (9.04) 17.86 (9.94)

Postintervention: −1.45 (–4.10 to 1.19) vs. −3.52 (–6.22 to −0.82); adjusted difference in change scores 2.06 (95% CI −1.55 to 5.68) Intermediate term: −1.15 (–3.84 to 1.53) vs. −2.21 (–4.91 to 0.50); adjusted difference in change scores 1.05 (95% CI −2.60 to 4.71)

Long term: 0.94 (–1.74 to 3.63) vs. −1.84 (–4.60 to 0.91); adjusted difference in change scores 2.79 (95% CI −0.91 to 6.48)

RMDQ (0-23)

Baseline (mean, SD): 13.51 (3.92) vs. 13.74 (3.65)

Postintervention:–2.47 (–3.86 to – 1.25) vs. −3.04 (–4.29 to −1.79); adjusted difference in change scores 0.58 (95% CI −1.08 to 2.24) Intermediate term: −2.54 (–3.76 to – 1.31) vs. −3.65 (–4.90 to −2.40); adjusted difference in change scores 1.11 (95% CI −0.56 to 2.79)

Long term: −2.12 (–3.36 to −0.89) vs. −3.74 (–5.01 vs. −2.48); adjusted difference in change scores 1.62 (95% CI −0.06 to 3.31)

A vs. B, adjusted mean change (SD) from baseline

BDI (0-63)

Baseline: 9.75 (6.68) vs. 10.45 (7.06)

Postintervention: −0.69 (–2.09 to 0.71) vs. −2.31 (–3.72 to −0.91); adjusted difference in change scores 1.62 (95% CI −0.36 to 3.61)

Intermediate term: −2.14 (–3.57 to – 0.71) vs. −2.41 (–3.81 to −1.00); adjusted difference in change scores 0.26 (95% CI −1.74 to 2.27)

Long term: −2.17 (–3.60 to −0.75) vs. −2.08 (–3.52 to −0.65); adjusted difference in change scores −0.09 (95% CI −2.11 to 1.93)

Global Improvement (1-7)

Postintervention: 4.53 (4.13 to 4.93) vs. 4.71 (4.30 to 5.11); adjusted difference in change scores −0.18 (95% CI −0.73 to 0.37)

Intermediate term: 4.00 (3.60 to 4.40) vs. 4.76 (4.36 to 5.17); adjusted difference in change scores −0.76 (95% CI −1.31 to −0.21)

Long term: 3.89 (3.49 to 4.29) vs. 4.54 (4.13 to 4.95); adjusted difference in change scores −0.65 (95% CI −1.21 to −0.10)

A vs. B, % (n/N) or mean (SD)

Harms

-

Increased pain in the lower back or radiating leg pain leading to withdrawal from the trial: 5.5% (3/55) vs. 0% (0/55)

-

No other adverse events were reported in either group

(effect modification by RDQ)

-

10th percentile of baseline RMDQ (=9)

-

50th percentile of baseline RMDQ (=14)

-

90th percentile of baseline RMDQ (=19)

Turner, 1990

USA

Duration of pain: 155 months

RCT

Poor

A. Comprehensive pain management program (n=18): 8 weeks (4 hours/week, 32 hours total), low intensity, Individual and group, Outpatient

B. Psychological Therapy alone (n=18): 8 weeks (2 hours/week, 16 hours total), low intensity, Individual and group, outpatient

Mean age: 44 years

Male: 52.1%

Race/ethnicity: White 100%

Pain etiology/type: Chronic LBP (≥6 months)

Disability: N/A

Comorbidities: NR

A vs. B, Mean (SD)

MPQ Pain Rating Index (0-78)

Baseline: 25.54 (12.41) vs. 20.96 (9.95)

Postintervention: 14.78 (11.44) vs. 17.71 (12.08)

Intermediate term: 13.29 (9.15) vs. 19.50 (15.72)

Long term: 18.21 (13.31) vs. 16.41 (13.63)

SIP (0-100)

Baseline: 8.50 (4.59) vs. 7.90 (6.43)

Postintervention: 3.63 (2.98) vs. 4.72 (4.12)

Intermediate term: 4.51 (4.68) vs. 7.60 (9.86)

Long term: 4.75 (3.40) vs. 5.25 (6.72)

A vs. B, Mean (SD)

CES-D (0-60)

Baseline: 12.38 (7.31) vs. 10.40 (7.51)

Postintervention: 7.36 (5.89) v vs. 8.08 (4.95)

Intermediate term: 8.29 (7.94) vs. 11.36 (8.30)

Long term: 10.00 (7.57) vs. 8.29 (7.74)

Patient satisfaction (1-7)

Postintervention: 5.50 (NR) vs. 4.00 (NR), p<0.05

A vs. B, Mean (SD)

Harms: NR

Patient satisfaction (1-7)

Postintervention: 5.50 (NR) vs. 4.00 (NR), p<0.05

Turner-Stokes, 2003

UK

Pain duration: 105.6 months

RCT

Poor

A. Comprehensive pain management program (73): 8 weeks (2 full afternoons per week, ~72 hours total), low intensity, group, Outpatient pain management clinics

B. Psychological Therapy alone (n=53): 8 weeks (1 hour every other week, 4 hours total), low intensity, group, outpatient

Mean age: 47 years

Male: 31%

Race/ethnicity: NR

Pain etiology/type: Chronic pain

Disability: NR

Comorbidities: NR

Mean difference (95% CI)

WHYMPI Pain Severity (0-6)

Baseline: adjusted difference −0.24 (95% CI −0.66 to 0.15), p=0.26

Postintervention: adjusted −0.07 (95% CI −0.50 to 0.35)

Intermediate term: adjusted difference −0.17 (95% CI −0.59 to 0.24)

WHYMPI Pain Interference subscale (0-6)

Baseline: adjusted difference −0.23 (95% CI −0.65 to 0.19)

Postintervention: adjusted −0.07 (95% CI −0.44 to 0.30)

Intermediate term: adjusted difference −0.28 (95% CI −0.69 to 0.13)

WHYMPI General Activities subscale (0-6)

Baseline: adjusted difference 0.22 (95% CI, −0.15 to 0.59)

Postintervention: adjusted difference −0.17 (95% CI −0.47 to 0.13)

Intermediate term: adjusted difference −0.11 (95% CI −0.44 to 0.21)

Mean difference (95% CI)

BDI (0-63)

Baseline: adjusted difference −1.12 (95% CI −4.43 to 2.41)

Postintervention: adjusted difference 0.91 (95% CI −1.89 to 3.71)

Intermediate term: adjusted difference −2.19 (95% CI −4.69 to 0.32)

STAI (20-80)

Baseline: adjusted difference 2.25 (95% CI −2.36 to 6.88)

Postintervention: adjusted difference −2.3 (95% CI −6.21 to 1.59), p=0.24

Intermediate term adjusted difference −3.43 (95% CI −7.81 to 0.94)

WHYMPI Control over Pain subscale (0-6)

Baseline: adjusted difference 0.46 (95% CI −0.04 to 0.97)

Postintervention: adjusted difference −0.15 (95% CI −0.59 to 0.29)

Intermediate term: adjusted difference 0.16 (95% CI −0.27 to 0.59)