Patients with chronic pain and severe disuse syndrome have pain with physiological, psychological, and social adaptations. The duration and severity of complaints, combined with previously failed treatments, makes them unsuitable for treatment in primary care. van Wilgen and coworkers conducted a prospective waiting list controlled study. A total of 32 patients with chronic pain for at least one year and severe disuse syndrome were included in an inpatient multidisciplinary cognitive behavioral treatment. Patients were assessed before the waiting list period, before the clinical phase, after the clinical phase, and after follow-ups of 6 months and one year. The visual analogue scale for pain and fatigue were assessed. Muscle strength of the arms and legs, arm endurance and a 6-minute walking test were used to assess physical outcome. The Symptom Checklist-90, RAND-36, pain cognition list and the Tampa scale for kinesiophobia were used to assess psychological outcome. The investigators found long-term significant (p < 0.001) improvements for pain, fatigue, walking distance, muscle strength, anxiety, depression, somatization, negative self-efficacy, and catastrophizing in the intervention period.

WHAT THE STUDY MAY MEAN TO YOU AS A HEALTH CARE PROVIDER: The authors concluded that an inpatient multidisciplinary cognitive behavioral program is beneficial for patients with chronic pain and a severe disuse syndrome. The benefits were considered as long-term in that follow-up data were gathered for a year after intervention.

WHAT THE STUDY MAY MEAN TO YOU AS A PATIENT: This was a well-designed and executed study from the Netherlands. It suggests that if you have chronic pain, a cognitive behavioral intervention may greatly benefit you. You might talk to your health care provider to see if such an intervention program for pain is available in your area.

CP van Wilgen et al. Chronic pain and severe disuse syndrome: Long-term outcome of an inpatient multidisciplinary cognitive behavioral program. Journal of Rehabilitation Medicine, 2009;41: 122-128.