Function-Versus Pain-Centred Treatment of Low Back Pain: Concepts and Outcome

Abstract

Return to work is the primary goal in the treatment of patients with low back pain. Treatment can be prescribed on the base of a biomechanical model assuming that a physical pathologic condition leads to pain and disability. It employs a "Pain-Centered Treatment" (PCT) administering various measures of pain therapy. The biopsychosocial model acknowledges the role of psychological and social factors as well as physical factors leading to permanent disability. On the base of this model "Function-Centered treatment" (FCT) emphasizing improvement in function and not primarily pain relief were developed to facilitate return to work. It remains unclear whether treatment based on the biomedical model with its restrictive recommendations is more effective in reducing work absenteeism than treatment applying the biopsychosocial model primarily emphasizing activity. We conducted a randomized controlled trial in Switzerland in patients with sick leave due to non-specific non-acute low back pain (LBP) to evaluate the effect of three weeks of function-centered compared with pain-centered in-patient rehabilitation^<1, 2)>. Inclusion Criteria were>6 weeks out of work due to chronic non-specific LBP. 174 patients were included; mean sick leave was 6.5 months. Groups were comparable at baseline. Results FCT vs PCT: at discharge self-efficacy +5.9 points vs. -7.4 points (ES=0.55, p=0.003), lifting capacity +2.3 kgs vs. +0.2kgs (ES=0.54, p=0.004): after 3 months days at work were 25.9 vs 15.8 (E=0.36, p=0.029): after 12 month days at work were 118 vs 74 (ES=0.35, p=0.011). From these findings we can conclude that FCT is more effective than PCT for increasing work days.