Patient expectations not met after treatment for chronic low back pain

Sanderson KB. J Pain Res. 2012. doi: 10.2147/JPR.S28636.

Patients who receive treatment for chronic low back pain generally expect more pain relief, less fatigue, less emotional distress and a lower level of interference than what they actually get, according to researchers in Florida.

The researchers looked to measure outcomes patients considered clinically meaningful by looking at pain, fatigue, emotional distress and level of interference and determining if patients were meeting their own success criteria. Forty-seven patients were randomly assigned into one of two groups. The first received opioid medication only, while the second received opioid medication and brief cognitive behavioral therapy. Assessments were conducted before and after treatment, with the post-treatment follow-up occurring at 3 months. Patient opinions were assessed through a patient-centered outcomes questionnaire taken before and after treatment.

The results, the authors wrote, showed patients did not meet their own success criteria in treatment across any of the four domains measured. Both treatment groups were found to experience a decrease in their level of pain and pain-related interference.

The authors reported no significant correlations between patient expectations prior to treatment and their assessed results following treatment.

“Patients sought larger reductions in pain, fatigue, level of distress and level of interference than they attained at post-treatment,” the authors wrote. “Enhancing opioid treatment with brief cognitive behavioral therapy did not yield additional improvements for the four domains assessed in patients with chronic low back pain.”