Multidisciplinary approach to chronic back pain: prognostic elements of the outcome

Clin Exp Rheumatol 1996; 14:281-8.

Elkayam O, Ben Itzhak S, Avrahami E, et al

Department of Rheumatology, Tel Aviv Sourasky Medical Center, Ichilov Hospital, Tel Aviv University, Sackler Faculty of Medicine, Israel.


This second study involved 67 people with chronic back pain who had not improved with previous physiotherapy.  Participants undertook a 4-week multidisciplinary pain management programme which included eight Alexander Technique lessons. Significant reductions occurred in levels of pain and amount of painkiller use; these benefits remained when re-tested 6 months later. Because the programme involved several different interventions it is not possible to know how much each one contributed to these improvements.


This study presents an evaluation of a multidisciplinary approach to patients with chronic back pain.


Sixty-seven patients with back pain of more than three months duration participated in a comprehensive 4 week program which included back schooling, psychological intervention, and treatment by acupuncture, chiropractic, the Alexander technique and a pain specialist. At admission to the study, patients were asked to complete a questionnaire concerning their socio-demographic background and disease history. Patients also underwent a psychological evaluation based on a questionnaire and an interview. On the basis of this evaluation, patients were graded on three criteria: (i) predominance of psychological factors; (ii) secondary gain; (iii) personality features. At the end of the treatment, patients were divided into three groups according to their degree of improvement. Patients were evaluated at the end of the four week program and after 6 months of follow up.


Significant improvement in the pain rating, pain frequency and analgesic drug consumption was observed in the treatment group, and was maintained for a period of 6 months. Satisfactory outcome was correlated to a moderate predominance of psychological factors, good functioning, a high level of motivation, and family support. Poor outcome was associated with a divorced marital status and unemployment, diffuse complaints, post surgery status, a high predominance of psychological factors, and the presence of secondary gain and personality disorders.


Patients with chronic back pain seem to benefit from this proposed multidisciplinary approach. The improvement was maintained for a period of 6 months. Outcome was clearly related to psychosocial factors.


Back problems
Pain: Other