Altering Beliefs about Pain and Impairment in a Functionally Oriented Treatment Program for Chronic Low Back Pain

OBJECTIVE: This study examined pain and impairment beliefs measured with the Pain and Impairment Relationship Scale, (PAIRS) of chronic low back pain patients during rehabilitation and hypothesized that pain beliefs would be stronger in drop-out subjects, decrease during treatment, and after treatment correlate strongly with disability measures. DESIGN: Prospective cohort. SETTING: Outpatient, functionally oriented rehabilitation program for chronic low back pain. PATIENTS: 72 consecutive chronic low back pain referral patients disabled from working because of pain. INVOLVEMENT: Interdisciplinary rehabilitation with a focus on intensive physical reconditioning was employed. OUTCOME MEASURES: Program completion versus drop-out groups and pretreatment and posttreatment pain, disability, depression, and PAIRS scores were compared. RESULTS: Thirty patients dropped out and 42 subjects completed treatment. The PAIRS scores at evaluation were similar for both groups. The PAIRS scores improved significantly during treatment (p < 0.001). Posttreatment PAIRS scores correlated highly with disability measures (r = 0.79, p < 0.001). CONCLUSION: Pain beliefs are of minimal value for predicting treatment compliance, but may be altered during functionally oriented treatment of chronic low back pain. Posttreatment disability closely mirrored attitudes and belief-associated pain and impairment.