Chronic pain is one of the most difficult problems that patients have to manage. Pain not only causes physical and psychological distress, but it can be difficult to treat. Woods and Asmundson pointed out that psychological treatments for chronic pain based on cognitive behavioral principles have been shown to be valuable in treating pain. They noted the use of a treatment using a fear-avoidance model of chronic musculoskeletal pain suggests chronic pain can be relieved by exposing individuals to movements and tasks that have been avoided due to fear of reinjury. As this graded exposure treatment was found to be beneficial in case studies, the authors conducted a trial to assess the effectiveness of graded exposure relative to other conditions. Forty-four chronic low back pain patients were randomly assigned to graded exposure, graded activity, or a wait-list condition. While only trend differences were observed for pain-related disability, patients in the graded exposure condition demonstrated: (a) significantly greater improvements on measures of fear of pain/movement, fear avoidance beliefs, pain-related anxiety, and pain self-efficacy when compared to those in the graded activity condition, and (b) significantly greater improvements on measures of fear-avoidance beliefs, fear of pain/movement, pain-related anxiety, pain catastrophizing, pain experience, and anxiety and depression when compared to those in the wait-list control condition. In addition, patients in the graded exposure condition maintained improvements in these areas at one-month follow-up.

VALUE OF STUDY TO READER: The study may have value for those who treat patients with chronic pain. However, while the results are impressive, a one-month follow-up is not. Patients with chronic pain need to learn techniques they can perform for as long as they experience pain. This may be, in some instances, for the remainder of their lives.

M.P. Woods, G.J. Asmundson. Evaluating the efficacy of graded in vivo exposure for the treatment of fear in patients with chronic back pain: A randomized controlled clinical trial. Pain, 2007.