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. ? ?
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