Attrition in Cognitive-behavioral Treatment of Chronic Back Pain

OBJECTIVES: The aim of this study was to identify pretreatment factors associated with dropout from outpatient individualized cognitive-behavioral treatment for chronic back pain. Despite the importance of this issue, little is known about determinants of dropout from cognitive-behavioral treatment for chronic pain. The presented study is a subanalysis of a larger study on cognitive-behavioral treatment for chronic back pain. METHODS: The study included 128 patients, who began a 25 session treatment. Three pretreatment domains (demographic variables, psychologic and pain-related symptom severity, and attitude toward treatment) and satisfaction with treatment within the first 3 sessions were considered as potential predictors of attrition. RESULTS: Twenty-three patients (18%) were classified as dropouts. Low psychologic distress, low medication intake, and low treatment satisfaction were significantly associated with dropout. Other demographic variables, pain-related variables, attributions, and attitude toward treatment were not associated with treatment attrition. The associations were only valid for early dropouts. DISCUSSION: It is concluded that cognitive-behavioral treatment of chronic pain should be adapted for less psychologically distressed patients to avoid treatment dropout.