Effectiveness of in-patient rehabilitation for sub-chronic and chronic low back pain by an integrative group treatment program (Swiss Multicentre Study).

In this multicentre intervention study, we compared an integrated group treatment program which combines psychological and education methods into a more active training approach, with the traditional individual approach of physiotherapy and physical procedures for sub-chronic and chronic low back pain. Our 411 patients had a 4-week inpatient treatment: 243 patients in an experimental program and 168 in a traditional program. Outcomes of 283 patients were assessed 3 months and 1 year after entry. The dropout rate was 31.1%. Both conditions demonstrated favourable initial effects on functional and psychological parameters, but the integrated approach showed better long-term results for work rehabilitation than the traditional approach. The most successful patients (n = 58) were younger and had a higher educational level in comparison to the unsuccessful subgroup (n = 71). The main conclusion is that an integrated approach promoting self control and behaviour change through educational measures achieves better long-term results than the traditional individual physiotherapy approach.

Comparison of integrated group therapy and group relaxation training for fibromyalgia.

OBJECTIVE: The efficacy of an integrated, psychological treatment program was tested in a controlled study involving 27 patients with chronic musculoskeletal pain (fibromyalgia). DESIGN: The experimental treatment program consisted of instruction in various self-help techniques (e.g., cognitive behavioral strategies, relaxation, physical exercises) as well as information on chronic pain. Control groups were instructed only in autogenic training. Measures of pain, daily activities, general symptoms, and psychological functioning were assessed before and after treatment, as well as at 4 months after termination of therapy (follow-up). RESULTS: At the end of treatment, 7 patients from the experimental group and 2 from the control group showed significant clinical improvement in 3 of 6 parameters (NS). At follow-up, the improvement was still present in 5 experimental cases but in none of the controls (p = 0.024). Successful patients had been sick for a shorter period of time and were less impaired by their condition. CONCLUSIONS: Psychological interventions in combination with physiotherapy can be effective in treating fibromyalgia patients, especially if applied early.

[Six years' experience with outpatient group treatment of fibrositis patients.]. / Sechs Jahre Erfahrung mit ambulanter Gruppenbehandlung für Weichteilrheumatiker : Generalisierte Tendomyopathie.

Since 1982, a total of 88 patients with refractory fibrositis have received treatment as part of an integrated group program within a psychiatric outpatient clinic working closely with the department of rheumatology. The best arrangement proved to be a series of 15 weekly two-hour sessions with groups of 8 patients. The program has three main elements: information, instruction in pain control strategies, and group discussion. The pain control strategies taught are cognitive behavioral techniques, relaxation, and exercises. A controlled study with 27 patients demonstrated that a comprehensive program of this kind was superior to instruction in autogenic training alone. Patient feedback confirmed the importance of the information given and of the group discussions; it is helpful to offer patients a wide range of pain control strategies that they can apply themselves. Our program makes it possible for a greater proportion of patients to learn one or more techniques affording some measure of pain relief. It is important for the therapists to adopt a positive and convincing attitude while restricting themselves to helping the patients to help themselves and avoiding power struggles. They should also be ready to accept the patients and their view of the illness, and not attempt to interpret the illness as the expression of something else.

[Demographic determinants in using a psychiatric polyclinic]. / Demographische Determinanten der Inanspruchnahme einer Psychiatrischen Poliklinik.

A sample of 500 patients of the Basle University Psychiatric Outpatient Department was analyzed regarding a number of demographic variables. The 390 patients in the sample who lived in the canton (municipality) of Basle-City were compared with the respective population of this urban area. There were significant differences in the utilization of outpatient psychiatric services depending on age, marital status and housing area. No significant sex-difference could be found. In addition--due to the relatively small sample--there were also no significant differences of diagnoses, although certain trends were visible.

[Generalized tendomyopathy: psychological profile of a patient group in the course of integrated treatment]. / Generalisierte Tendomyopathie: Psychologisches Profil einer Patientengruppe im Verlauf einer integrierten Behandlung.

27 patients suffering from fibrositis were studied using a series of psychological tests in the course of an integrated group treatment program. In addition, their behaviour in the treatment program was observed and information about their behaviour in interpersonal conflicts was gathered. The results confirmed earlier observations that these patients show similar patterns in a projective test (Rosenzweig Picture Frustration Test) as patients with other rheumatic or other psychosomatic affections. The observations in the group sessions gave further support to these findings. However, in their self-evaluation with a personality inventory (Freiburger Persönlichkeits-Inventar), these people described themselves as more disturbed than the other kinds of patients mentioned. But this disturbance seems to be rather the consequence than the cause of this chronic illness of unclear origin. These signs of emotional disturbance were more distinct in those patients who had been suffering for longer from their illness and showed a poorer response to our treatment program.

Psychosocial criteria for patient selection: review of studies and concepts for understanding chronic back pain.

Eighteen studies on psychosocial aspects of back pain are reviewed. Among six studies trying to differentiate pain of organic and functional origin, only two studies claim to be able to make such a distinction. Psychological disturbance--studied with a variety of instruments--proved to be an important factor affecting the reporting and measurement of pain (eight studies). Low disturbance can predict good outcome in both organic and functional pain (six studies). Psychological disturbance, however, seems to be equally the consequence and the cause of pain, and pain relief reduces psychological disturbance. Thus, the dichotomy of organic vs. psychogenic pain must be dismissed, and a holistic, interactive systems model must be advocated. Factors causing acute back pain should be differentiated from those leading to chronicity. A model for understanding the evolution of chronicity and a checklist for possible factors promoting chronicity are presented.