Chronic low back pain is a national public health problem of major proportions, resulting in tremendous cost to the patient and to society. The ineffectiveness of traditional medical and surgical treatments for this syndrome and the recognition of the important role of psychological processes in chronic pain have led to the application of various psychological therapies, either alone or in conjunction with other therapeutic modalities, to low back pain problems. However, there is a lack of well-designed, controlled studies of the short- and long-term efficacy of such interventions.
The aim of this project is to evaluate the long-term efficacy of the widely used operant behavioral approach for chronic low back pain, as well as that of its two major components. Prior research conducted by the P.I. has demonstrated that this treatment produces decreased physical and psychosocial impairment. The proposed study will allow chronic low back patients who participated in group outpatient programs of (a) behavioral therapy and regular exercise, (b) behavioral therapy only, or (c) regular exercise only to be assessed six and twelve months following treatment. Assessment will include a wide range of patient- and spouse-related measures of pain, mood, pain-related cognitions, physical and psychosocial impairment, and medication and health care utilization. Measures of overt pain behaviors and muscular strength and fitness will also be obtained. Results will provide important information concerning the long-term effects of behavioral therapy on various aspects of chronic low back pain problems. In addition, the relative contributions of exercise vs. behavioral techniques to these effects will be elucidated.
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