Between 10 and 28 percent of Americans suffer from chronic low back pain (CLBP). Chronic pain self-management programs that include behavioral and cognitive-behavioral therapies (CBT) have been demonstrated as effective in improving pain, function, and quality of life. These techniques are endorsed as an important component of a comprehensive pain management approach by several national organizations, including the American Pain Society and the Joint Commission for the Accreditation of Health Care Organizations. Since access to CBT for chronic pain is limited, there is a tremendous need for safe, effective, low-cost self- management programs for individuals suffering from CLBP. Toward this end, this project developed an interactive online intervention, the Wellness Workbook (WW). In Phase I research, a pilot version of the WW was developed and customized for individuals with CLBP. The WW is an interactive web-based intervention consisting of a mind/body treatment rationale, pain education, and instruction in cognitive-behavioral pain management techniques. The efficacy of the Phase I WW was evaluated in a randomized, waitlist-controlled trial with 118 individuals with CLBP. Results indicated that those who used the Phase I version of the WW for 3 weeks endorsed more adaptive beliefs regarding pain control and showed improvements in self-efficacy, mood regulation, helplessness, and fearful avoidance of physical activity. Phase II will consist of further development and piloting of the WW and supplemental tools such as a moderated discussion board and a physical activity planning tool. Efficacy of the final WW intervention will be evaluated in an RCT with 198 CLBP patients recruited over the internet. Intervention group participants will use the WW intervention for 10 weeks and control group participants will be given print materials. Both groups will be receive bi-weekly telephone check- ins. Outcome variables will include pain-related disability, pain interference, disabling attitudes and beliefs, mood and physical activity levels. Assessments will be given at base-line, post- intervention (10 weeks) and at 8 weeks follow-up. The WW will be marketed through primary care and specialty clinics and will be available at low cost to individual patients.
Chronic lower back pain is one of the most widely experienced health problems in the United States, is a leading cause of disability and has an estimated cost of $30 to $70 billion yearly. Cognitive and behavioral approaches (CBT) are established, empirically supported treatments that improve quality of life, functioning and reduce pain-related disability for chronic pain patients. The present project will develop a web-based CBT intervention for chronic low back pain which will be effective, convenient, private and available for low cost to patients regardless of location or insurance coverage.