Background: Psychological factors influence the development and persistence of chronic low back pain (CLBP) and may impair the psychosocial rehabilitation success.
Objective: To examine the effects of a combined pain competence and depression prevention training compared to the pain competence training alone and as well as the patients' stages of pain on the long-term psychosocial rehabilitation success.
Methods: In this controlled multicentre study with cluster-block randomization, patients with CLBP in different stages of pain (I-III) received either pain competence training (control group, CG; n= 255) or combined pain competence and depression prevention training (intervention group, IG; n= 271; per protocol). Depressive symptoms (primary outcome), anxiety, somatization, health status, and average pain intensity (secondary outcomes) were assessed up to 12 months of follow-up. Standardised questionnaires were used to record the outcomes, which were filled out by the patients themselves. Analyses after multiple imputation (N= 1225) were conducted to validate multi- and univariate analyses of variance.
Results: Patients in stage of pain I and II showed significant improvements in depressive symptoms, anxiety, mental health, and average pain intensity at the 12-month follow-up, irrespective from treatment condition.
Conclusions: Multidisciplinary rehabilitation seems to be appropriate for patients with CLBP in stage of pain I and II. However, patients in stage of pain III need more psychological treatments to manage their mental comorbidities.
Keywords: Low back pain; Mainz Pain Staging System; mental disorders; multidisciplinary rehabilitation; pain chronification.