Comparison of a biopsychosocial therapy (BT) with a conventional biomedical therapy (MT) of subacute low back pain in the first episode of sick leave: a randomized controlled trial

Abstract

This randomized controlled clinical trial compares the effectiveness of a biopsychosocial treatment with a solely conventional biomedical therapy in patients with subacute low back pain using parameters for pain intensity, functional status, depressive dysfunction and work performance. Sixty-four patients with a first-time sick leave between 3 and 12 weeks due to low back pain were randomly assigned to either a conventional biomedical therapy (MT; n=33) group, or a biopsychosocial therapy (BT; n=31) group including a psychotherapeutic module; both in accordance with a standardized 3 weeks inpatient treatment. Pain intensity, functional back capacity, clinical parameters and depressive dysfunction revealed significant improvement in both treatment groups at end of 3 weeks therapy (T1). However, at 6 months (T2), analysis revealed significant better results for nearly all parameters in the BT group that showed further improvement from T1 to T2, whereas the values in the MT group deteriorated from T1 back to the baseline values. During the 2-year period after therapy, 10% in MT and 59% in BT required no further sick leave due to low back pain. The results of the study indicate that a psychotherapeutic element in the treatment of low back pain appears to positively influence pain, functional status and work performance when conducted at an early stage of chronification and helps in the achievement of a better outcome.

Fig. 1

Patient flow diagram

Fig. 2

Changes in pain intensity on a numeric rating scale (NRS, scores ranged from 0 no pain to 10 maximum pain severity; at T2 significant difference of change between the treatment groups MT and BT: ****P<0.0001)

Fig. 3

Changes in subjective functional capacity of the back (scale FFbH-R: scores in percentage of unrestricted capacity) at T2 significant difference of change to T0 between treatment groups MT and BT; **P=0.005)

Fig. 4

Changes of depressive dysfunction (scale CES-D; at T2 significant difference of change to T0 between the treatment groups MT and BT; **P=0.0034)