Nowhere do psychiatric and physical pathologies interface more prominently than in pain disorders. Patients with chronic pain are at increased risk for anxiety disorders, substance abuse disorders, depression, suicide and sleep disorders. There is now a consensus that it is important to effectively treat pain patients in the acute stage in order to prevent the development of chronic and costly comorbid mental and physical health disability problems. As a continuation of two earlier NIMH funded projects, the present proposed study is designed to evaluate the therapeutic- and cost effectiveness of a three-component biopsychosocial model of early intervention in order to maximize the prevention of chronicity in high-risk acute low back pain patients. This translational biopsychosocial research will be conducted in partnership with the largest workers' compensation company in the U.S. (Liberty Mutual). For this study, high-risk acute low back pain patients will be randomly assigned to one of four intervention conditions, one of which is a non-intervention condition (45 subjects/condition). The differential impact of these conditions will be evaluated in terms of the prevention of chronic mental and physical health disability evaluated during a one-year follow-up period after intervention. A secondary goal of this project is to begin to evaluate the validity of Melzack's neuromatrix model of the relationship between emotional distress and pain within the context of the present experimental design. Major mental health outcome variables will include DSM-IV Axis I and Axis II diagnoses, anxiety/fear, depression, coping skills, and psychotropic medication use. Major physical health outcomes will include socioeconomic variables such as return-to-work, injury recurrence, healthcare utilization, and functional disability related to pain, as well as associated free cortisol levels. It is hypothesized that the high-risk non-intervention group patients will display significantly higher rates of chronic mental and physical health disability at one year relative to the other intervention groups; the most comprehensive biopsychosocial intervention will be associated with the lowest rates. These results will have implications for potentially significant healthcare cost savings for this highly prevalent co-morbid disability problem. ? ?

Agency
National Institute of Health (NIH)
Institute
National Institute of Mental Health (NIMH)
Type
Research Project (R01)
Project #
5R01MH046452-10
Application #
6885405
Study Section
Special Emphasis Panel (ZRG1-RPHB-3 (01))
Program Officer
Muehrer, Peter R
Project Start
1991-08-01
Project End
2005-08-31
Budget Start
2005-05-01
Budget End
2005-08-31
Support Year
10
Fiscal Year
2005
Total Cost
$96,913
Indirect Cost
Name
University of Texas Sw Medical Center Dallas
Department
Psychiatry
Type
Schools of Medicine
DUNS #
800771545
City
Dallas
State
TX
Country
United States
Zip Code
75390
Neblett, Randy; Brede, Emily; Mayer, Tom G et al. (2013) What is the best surface EMG measure of lumbar flexion-relaxation for distinguishing chronic low back pain patients from pain-free controls? Clin J Pain 29:334-40
Whitfill, Travis; Haggard, Robbie; Bierner, Samuel M et al. (2010) Early intervention options for acute low back pain patients: a randomized clinical trial with one-year follow-up outcomes. J Occup Rehabil 20:256-63
Kidner, Cindy L; Mayer, Tom G; Gatchel, Robert J (2009) Higher opioid doses predict poorer functional outcome in patients with chronic disabling occupational musculoskeletal disorders. J Bone Joint Surg Am 91:919-27
Gatchel, Robert J; Peng, Yuan Bo; Peters, Madelon L et al. (2007) The biopsychosocial approach to chronic pain: scientific advances and future directions. Psychol Bull 133:581-624
Heckler, David R; Gatchel, Robert J; Lou, Leland et al. (2007) Presurgical Behavioral Medicine Evaluation (PBME) for implantable devices for pain management: a 1-year prospective study. Pain Pract 7:110-22
Stowell, Anna Wright; Gatchel, Robert J; Wildenstein, Lynn (2007) Cost-effectiveness of treatments for temporomandibular disorders: biopsychosocial intervention versus treatment as usual. J Am Dent Assoc 138:202-8
McGeary, Donald D; Mayer, Tom G; Gatchel, Robert J (2006) High pain ratings predict treatment failure in chronic occupational musculoskeletal disorders. J Bone Joint Surg Am 88:317-25
Gatchel, Robert J; Stowell, Anna Wright; Wildenstein, Lynn et al. (2006) Efficacy of an early intervention for patients with acute temporomandibular disorder-related pain: a one-year outcome study. J Am Dent Assoc 137:339-47
Gatchel, Robert J; Mayer, Tom G; Theodore, Brian R (2006) The pain disability questionnaire: relationship to one-year functional and psychosocial rehabilitation outcomes. J Occup Rehabil 16:75-94
Hatten, Alyson Lieban; Gatchel, Robert J; Polatin, Peter B et al. (2006) A cost-utility analysis of chronic spinal pain treatment outcomes: converting SF-36 data into quality-adjusted life years. Clin J Pain 22:700-11

Showing the most recent 10 out of 48 publications