Sustainability of cognitive behavioural interventions for chronic back pain: A long‐term follow‐up
Open accessAbstract
BACKGROUND: There is a significant research gap with respect to the long-term sustainability of psychological treatment effects in chronic pain patients. This study aimed to investigate long-term treatment effects of two psychological treatments: cognitive behavioural therapy (CBT) as a broad-spectrum approach and exposure as a specific intervention for fear-avoidant pain patients. METHODS: Patients with chronic low back pain were randomized to CBT or exposure in vivo. Long-term follow-up (LTFU) data were available for 64 patients up to 8 years after treatment, with a response rate of 73%. The primary outcomes were pain-related disability and pain intensity and secondary outcomes were emotional distress, psychological flexibility, catastrophizing and pain-related fear. The data analysis was performed with longitudinal multilevel modelling. RESULTS: Multilevel analyses showed improvements in all primary outcomes as well as all secondary outcomes from pre-treatment to LTFU for both treatments. The mean proportion of cases meeting reliable and clinical improved criteria in all primary outcome was 36% (range: 22%-46%) in the exposure group and 50% (range: 33%-60%) in the CBT group. Dropout analyses revealed significantly higher deterioration rates over time. Pre-treatment to LTFU effect sizes of the primary outcomes ranged from 0.54 to 1.59. CONCLUSIONS: Our results indicate that the effects of psychological treatments might be stable over several years. Treatment gains for exposure as a stand-alone treatment seem to be of shorter duration than a general CBT intervention. Thus, psychological treatments might offer a promising and sustainable long-term perspective for patients with chronic back pain. SIGNIFICANCE: The long-term stability of treatment effects is a highly neglected issue despite its inherent importance in the context of chronic pain. This study is the first to investigate treatment effects of cognitive behavioural therapy and in vivo exposure in chronic back pain sufferers up to 8 years after treatment. The findings contribute to an understanding of the sustainability of psychological cognitive behavioural therapy-based intervention effects.
Integrity signals
Registry
Cites
Statistics
Claims the paper makes
Claims other papers make about this one
Each is checked against this paper’s own text: does it say what the citing paper says it does?
Further analyses of pilot study data show in an 8-year follow-up that both CBT and EXP provide sustained positive effects for patients with chronic back pain.
“Further analyses of the pilot study data show in an 8-year follow-up that both CBT and EXP provide sustained positive effects for patients with chronic back pain [20].”
From EFFects of Exposure and Cognitive behavioral Therapy for chronic BACK pain (“EFFECT-BACK”): study protocol for a randomized controlled trial (2024) · cites this paper as [20]
Cites
The Hospital Anxiety and Depression Scale
Zigmond, A. S., & Snaith, R. P. (1983) · Acta Psychiatrica Scandinavica · doi:10.1111/j.1600-0447.1983.tb09716.x · Cited by 47,139 · see citing works
The Pain Catastrophizing Scale: Development and validation.
Sullivan, M. J. L., Bishop, S. R., & Pivik, J. (1995) · Psychological Assessment · doi:10.1037//1040-3590.7.4.524 · Cited by 8,227 · see citing works
Jacobson, N. S., & Truax, P. (1991) · Journal of Consulting and Clinical Psychology · doi:10.1037/0022-006x.59.1.12 · Cited by 7,770 · see citing works
Core outcome measures for chronic pain clinical trials: IMMPACT recommendations
Dworkin, R. H., Turk, D. C., Farrar, J. T., Haythornthwaite, J. A., Jensen, M. P., Katz, N. P., Kerns, R. D., Stucki, G., Allen, R. R., Bellamy, N., et al. (2005) · Pain · doi:10.1016/j.pain.2004.09.012 · Cited by 3,732 · see citing works
The Efficacy of Cognitive Behavioral Therapy: A Review of Meta-analyses
Hofmann, S. G., Asnaani, A., Vonk, I. J. J., Sawyer, A. T., & Fang, A. (2012) · Cognitive Therapy and Research · doi:10.1007/s10608-012-9476-1 · Cited by 3,445 · cited 1× · see citing works
“Among possible treatments, cognitive behavioural therapy (CBT) provides the most established evidence base for reducing pain-related disability, emotional distress and pain intensity (Hofmann et al., 2012; Williams et al., 2020).”
BackgroundOstelo, R. W. J. G., Deyo, R. A., Stratford, P., Waddell, G., Croft, P., Von Korff, M., Bouter, L. M., & de Vet, H. C. (2008) · Spine · doi:10.1097/brs.0b013e31815e3a10 · Cited by 2,009 · see citing works
Psychological therapies for the management of chronic pain (excluding headache) in adults
Williams, A. C. D. C., Eccleston, C., & Morley, S. (2012) · Cochrane Database of Systematic Reviews · doi:10.1002/14651858.cd007407.pub3 · Cited by 1,634 · see citing works
Responsiveness of the Numeric Pain Rating Scale in Patients with Low Back Pain
Childs, J. D., Piva, S. R., & Fritz, J. M. (2005) · Spine · doi:10.1097/01.brs.0000164099.92112.29 · Cited by 1,481 · see citing works
The IASP classification of chronic pain for ICD-11: chronic primary pain
Nicholas, M., Vlaeyen, J. W. S., Rief, W., Barke, A., Aziz, Q., Benoliel, R., Cohen, M., Evers, S., Giamberardino, M. A., Goebel, A., et al. (2019) · Pain · doi:10.1097/j.pain.0000000000001390 · Cited by 1,424 · see citing works
Self-citationThe Pain Disability Index: psychometric properties
Tait, R. C., Chibnall, J. T., & Krause, S. (1990) · Pain · doi:10.1016/0304-3959(90)90068-o · Cited by 952 · see citing works
The pain anxiety symptoms scale: development and validation of a scale to measure fear of pain
McCracken, L. M., Zayfert, C., & Gross, R. T. (1992) · Pain · doi:10.1016/0304-3959(92)90113-p · Cited by 950 · see citing works
Jacobson, N. S., Roberts, L. J., Berns, S. B., & McGlinchey, J. B. (1999) · Journal of Consulting and Clinical Psychology · doi:10.1037//0022-006x.67.3.300 · Cited by 853 · see citing works
Jacobson, N. S., Roberts, L. J., Berns, S. B., & McGlinchey, J. B. (1999) · Journal of Consulting and Clinical Psychology · doi:10.1037/0022-006x.67.3.300 · Cited by 853 · see citing works
Robustness issues in multilevel regression analysis
Maas, C. J. M., & Hox, J. J. (2004) · Statistica Neerlandica · doi:10.1046/j.0039-0402.2003.00252.x · Cited by 837 · see citing works
The Quebec Back Pain Disability Scale
Kopec, J. A., Esdaile, J. M., Abrahamowicz, M., Abenhaim, L., Wood-Dauphinée, S., Lamping, D. L., & Williams, J. I. (1995) · Spine · doi:10.1097/00007632-199502000-00016 · Cited by 660 · see citing works
Psychological therapies for the management of chronic pain (excluding headache) in adults
Williams, A. C. D. C., Fisher, E., Hearn, L., & Eccleston, C. (2020) · Cochrane Database of Systematic Reviews · doi:10.1002/14651858.cd007407.pub4 · Cited by 605 · see citing works
A method of assessing change in a single subject: An alteration of the RC index
Christensen, L., & Mendoza, J. L. (1986) · Behavior Therapy · doi:10.1016/s0005-7894(86)80060-0 · Cited by 536 · see citing works
Leeuw, M., Goossens, M. E. J. B., van Breukelen, G. J. P., de Jong, J. R., Heuts, P. H. T. G., Smeets, R. J. E. M., Köke, A. J. A., & Vlaeyen, J. W. S. (2008) · Pain · doi:10.1016/j.pain.2007.12.009 · Cited by 393 · see citing works
Grönblad, M., Hupli, M., Wennerstrand, P., Järvinen, E., Lukinmaa, A., Kouri, J.-P., & Karaharju, E. O. (1993) · The Clinical Journal of Pain · doi:10.1097/00002508-199309000-00006 · Cited by 390 · cited 1× · see citing works
“It has good internal consistency, test– retest reliability and construct validity (Grönblad et al., 1993; Soer et al., 2013; Tait et al., 1990).”
BackgroundThe course of chronic pain in the community: Results of a 4-year follow-up study
Elliott, A. M., Smith, B. H., Hannaford, P. C., Smith, W. C., & Chambers, W. A. (2002) · Pain · doi:10.1016/s0304-3959(02)00138-0 · Cited by 384 · see citing works
Meyer, K., Sprott, H., & Mannion, A. F. (2008) · Journal of Psychosomatic Research · doi:10.1016/j.jpsychores.2007.12.004 · Cited by 319 · see citing works
Behinderungseinschätzung bei chronischen Schmerzpatienten
Dillmann, U., Nilges, P., Saile, H., & Gerbershagen, H. U. (1994) · Der Schmerz · doi:10.1007/bf02530415 · Cited by 302 · see citing works
When pain gets stuck: the evolution of pain chronification and treatment resistance
Borsook, D., Youssef, A. M., Simons, L., Elman, I., & Eccleston, C. (2018) · Pain · doi:10.1097/j.pain.0000000000001401 · Cited by 281 · see citing works
The Quebec Back Pain Disability Scale: Conceptualization and development
Kopec, J. A., Esdaile, J. M., Abrahamowicz, M., Abenhaim, L., Wood-Dauphinee, S., Lamping, D. L., & Williams, J. I. (1996) · Journal of Clinical Epidemiology · doi:10.1016/0895-4356(96)00526-4 · Cited by 242 · see citing works
Psychometric evaluation of the Pain Anxiety Symptoms Scale (PASS) in chronic pain patients
Roelofs, J., McCracken, L., Peters, M. L., Crombez, G., van Breukelen, G., & Vlaeyen, J. W. S. (2004) · Journal of Behavioral Medicine · doi:10.1023/b:jobm.0000019850.51400.a6 · Cited by 196 · see citing works
Morley, S., Williams, A., & Hussain, S. (2008) · Pain · doi:10.1016/j.pain.2008.02.025 · Cited by 194 · see citing works
Vowles, K. E., McCracken, L. M., & O’Brien, J. Z. (2011) · Behaviour Research and Therapy · doi:10.1016/j.brat.2011.08.002 · Cited by 179 · cited 2× · see citing works
“For this long time period, change rates are still high, as well as compared with previous studies that found improvement rates between 30% and 40% with shorter time intervals (Nicholas et al., 2017; Vowles et al., 2011).”
ResultWicksell, R. K., Lekander, M., Sorjonen, K., & Olsson, G. L. (2010) · European Journal of Pain · doi:10.1016/j.ejpain.2009.11.015 · Cited by 176 · see citing works
Extensive Validation of the Pain Disability Index in 3 Groups of Patients With Musculoskeletal Pain
Soer, R., Köke, A. J. A., Vroomen, P. C. A. J., Stegeman, P., Smeets, R. J. E. M., Coppes, M. H., & Reneman, M. F. (2013) · Spine · doi:10.1097/brs.0b013e31828af21f · Cited by 155 · see citing works
Cognitive-Behavioral Approach to the Treatment of Chronic Pain Patients
Turk, D. (2003) · Regional Anesthesia & Pain Medicine · doi:10.1016/s1098-7339(03)00392-4 · Cited by 146 · see citing works
Clinical significance methods: Which one to use and how useful are they?
McGlinchey, J. B., Atkins, D. C., & Jacobson, N. S. (2002) · Behavior Therapy · doi:10.1016/s0005-7894(02)80015-6 · Cited by 128 · see citing works
Boersma, K., Södermark, M., Hesser, H., Flink, I. K., Gerdle, B., & Linton, S. J. (2019) · Pain · doi:10.1097/j.pain.0000000000001575 · Cited by 123 · see citing works
Fersum, K. V., Smith, A. J., Kvåle, A., Skouen, J. S., & O’Sullivan, P. (2019) · European Journal of Pain · doi:10.1002/ejp.1399 · Cited by 122 · see citing works
Graded Exercise for Recurrent Low-Back Pain
Rasmussen-Barr, E., Äng, B. O., Arvidsson, I., & Nilsson-Wikmar, L. B. (2009) · Spine · doi:10.1097/brs.0b013e318191e7cb · Cited by 103 · see citing works
Glombiewski, J. A., Holzapfel, S., Riecke, J., Vlaeyen, J. W. S., de Jong, J., Lemmer, G., & Rief, W. (2018) · Journal of Consulting and Clinical Psychology · doi:10.1037/ccp0000298 · Cited by 81 · cited 11× · see citing works
“The present study is a long-term follow-up of Glombiewski et al.'s (2018) RCT on the effectiveness of in vivo exposure in individuals suffering from CLBP with elevated levels of fear and avoidance.”
BackgroundMethodResultInfluentialSelf-citationLong-term, non-specific spinal pain: reliable and valid subgroups of patients
Bergström, G., Bodin, L., Jensen, I. B., Linton, S. J., & Nygren, Å. L. (2001) · Behaviour Research and Therapy · doi:10.1016/s0005-7967(99)00175-8 · Cited by 69 · see citing works
Development and course of chronic pain over 4 years in the general population: The HUNT pain study
Landmark, T., Dale, O., Romundstad, P., Woodhouse, A., Kaasa, S., & Borchgrevink, P. C. (2018) · European Journal of Pain · doi:10.1002/ejp.1243 · Cited by 65 · see citing works
Rickardsson, J., Gentili, C., Holmström, L., Zetterqvist, V., Andersson, E., Persson, J., Lekander, M., Ljótsson, B., & Wicksell, R. K. (2021) · European Journal of Pain · doi:10.1002/ejp.1723 · Cited by 64 · cited 1× · see citing works
“…recent randomized controlled trials (RCT)s examined the long-term effects of internet-delivered CBT (Murray et al., 2020) and acceptance and commitment therapy (Rickardsson et al., 2021) interventions, demonstrating that improvements in disability could be maintained up to 1 year after treatment.”
BackgroundNicholas, M. K., Asghari, A., Blyth, F., Wood, B. M., Murray, R., McCabe, R., Brnabic, A. J. M., Beeston, L., Corbett, M., Sherrington, C., et al. (2016) · Pain · doi:10.1097/j.pain.0000000000000729 · Cited by 56 · see citing works
Glette, M., Stiles, T. C., Borchgrevink, P. C., & Landmark, T. (2019) · Journal of Pain · doi:10.1016/j.jpain.2019.10.008 · Cited by 55 · see citing works
Long‐Term Outcomes of Multidisciplinary Rehabilitation for Chronic Musculoskeletal Pain
Volker, G., van Vree, F., Wolterbeek, R., van Gestel, M., Smeets, R., Köke, A. J. A., & Vlieland, T. P. M. V. (2016) · Musculoskeletal Care · doi:10.1002/msc.1141 · Cited by 41 · see citing works
Bergström, G., Bergström, C., Hagberg, J., Bodin, L., & Jensen, I. (2010) · European Journal of Pain · doi:10.1016/j.ejpain.2009.06.008 · Cited by 38 · see citing works
Barke, A., Riecke, J., Rief, W., & Glombiewski, J. A. (2015) · BMC Musculoskeletal Disorders · doi:10.1186/s12891-015-0641-z · Cited by 37 · cited 2× · see citing works
“The German version has good psychometric properties (Barke et al., 2015).”
BackgroundMethodSelf-citationBeemster, T. T., van Bennekom, C. A. M., van Velzen, J. M., Reneman, M. F., & Frings‐Dresen, M. H. W. (2018) · Health and Quality of Life Outcomes · doi:10.1186/s12955-018-1000-1 · Cited by 37 · see citing works
Geissner, E. (1999) · Zeitschrift für Klinische Psychologie und Psychotherapie · doi:10.1026//0084-5345.28.4.280 · Cited by 30 · see citing works
Schemer, L., Vlaeyen, J. W. S., Doerr, J. M., Skoluda, N., Nater, U. M., Rief, W., & Glombiewski, J. A. (2018) · Behaviour Research and Therapy · doi:10.1016/j.brat.2018.07.002 · Cited by 28 · see citing works
Self-citationMurray, C. B., de la Vega, R., Loren, D. M., & Palermo, T. M. (2019) · Journal of Pain · doi:10.1016/j.jpain.2019.10.001 · Cited by 26 · see citing works
Riecke, J., Holzapfel, S., Rief, W., Lachnit, H., & Glombiewski, J. (2016) · Journal of Pain Research · doi:10.2147/jpr.s92615 · Cited by 23 · see citing works
Self-citationRiecke, J., Holzapfel, S., Rief, W., & Glombiewski, J. A. (2013) · Trials · doi:10.1186/1745-6215-14-203 · Cited by 22 · see citing works
Self-citationGeneralizability of harm and pain expectations after exposure in chronic low back pain patients
Riecke, J., Rief, W., Vlaeyen, J. W. S., & Glombiewski, J. A. (2020) · European Journal of Pain · doi:10.1002/ejp.1604 · Cited by 19 · see citing works
Self-citationPain Management Program Follow-Ups. A National Survey of Current Practice in the United Kingdom
Peat, G. M., Moores, L., Goldingay, S., & Hunter, M. (2001) · Journal of Pain and Symptom Management · doi:10.1016/s0885-3924(00)00259-1 · Cited by 18 · see citing works
Groot, D., van Hooff, M. L., Kroeze, R. J., Monshouwer, M., O’Dowd, J., Horsting, P., & Spruit, M. (2019) · European Spine Journal · doi:10.1007/s00586-019-05967-6 · Cited by 18 · see citing works
Emilson, C., Demmelmaier, I., Bergman, S., Lindberg, P., Denison, E., & Åsenlöf, P. (2016) · Clinical Rehabilitation · doi:10.1177/0269215516639356 · Cited by 12 · see citing works
Turner, J. A. (2013) · Pain · doi:10.1016/j.pain.2013.02.028 · Cited by 5 · see citing works
Boonstra, A. M., Hoogers, J. M. B., Stewart, R. E., Reneman, M. F., & Preuper, H. R. S. (2021) · International Journal of Rehabilitation Research · doi:10.1097/mrr.0000000000000467 · Cited by 4 · see citing works
Flagged first, then by citations
Cited by
Sorted by citations
Current Progress on Postoperative Cognitive Dysfunction: An Update
Sun, J., Du, X., & Chen, Y. (2024) · Journal of Integrative Neuroscience · doi:10.31083/j.jin2312224 · Cited by 23 · see citing works
Forden, G., Ronaghan, S., Williams, P. J., Fish, S., & Ford, C. E. L. (2023) · Disability and Rehabilitation · doi:10.1080/09638288.2023.2283113 · Cited by 10 · see citing works
Anselmo, A., Pagano, M. C., Cappadona, I., Cardile, D., Calabrò, R. S., & Corallo, F. (2025) · Current Pain and Headache Reports · doi:10.1007/s11916-024-01340-5 · Cited by 12 · see citing works
Dorfman, C. S., Heapy, A. A., Williams, A. C. D. C., & Keefe, F. J. (2025) · Pain · doi:10.1097/j.pain.0000000000003552 · Cited by 8 · see citing works
Vogt, R., Haas, J., Baumann, L., Sander, A., Klose, C., Riecke, J., Rief, W., Bingel, U., Maser, D., Witthöft, M., et al. (2024) · Trials · doi:10.1186/s13063-024-08017-9 · Cited by 3 · see citing works
“Further analyses of the pilot study data show in an 8-year follow-up that both CBT and EXP provide sustained positive effects for patients with chronic back pain [20].”
BackgroundSelf-citationFrom the lab to the clinic: Advancing pain exposure using principles of functional analysis
Schemer, L., Vlaeyen, J. W. S., & Glombiewski, J. A. (2024) · Current Opinion in Psychology · doi:10.1016/j.copsyc.2024.101982 · Cited by 6 · see citing works
Self-citationFeldmeier, G., Zutz, S., Höck, J., Wollny, A., Kropp, P. A., Altiner, A., & Löffler, C. (2025) · BMC Nursing · doi:10.1186/s12912-025-03211-9 · Cited by 2 · see citing works
Gallo, E., Maisuradze, M., & Amato, G. (2025) · RIVISTA DI STUDI SULLA SOSTENIBILITA · doi:10.3280/riss2025oa19880 · Cited by 2 · see citing works
Kognitive Verhaltenstherapie mit Herzratenvariabilitäts-Biofeedback bei chronischen Schmerzen
Wünsche, S., Krempel, L., & Martin, A. (2024) · Die Psychotherapie · doi:10.1007/s00278-024-00732-7 · Cited by 1 · see citing works
Lara, L. V. G., Granizo, V. C., & Izurieta, A. P. R. (2025) · Revista de la Facultad de Ciencias Médicas de Córdoba · doi:10.31053/1853.0605.v82.n4.48710 · Cited by 1 · see citing works
IoT-Driven Posture Correction for Chronic Back Pain Mitigation Using Bayesian Networks
Sampathrajan, R., Mohammed, A. J., Hariprasad, M., Dinesh Babu, S., Sujatha, S. S., & Pirabanchana, M. (2025) · doi:10.1109/iccsp64183.2025.11088779 · Cited by 1 · see citing works
Exposition bei chronischen Rückenschmerzen – Effektivität und praktische Umsetzung
Vogt, R., Schemer, L., & Glombiewski, J. A. (2024) · PiD - Psychotherapie im Dialog · doi:10.1055/a-2249-8593
Self-citationTung, C.-C., Lee, W., Yeh, W.-B., & Chang, R. (2025) · Journal of Pain · doi:10.1016/j.jpain.2025.104780
Efficacy of psilocybin on death anxiety in terminal patients: a narrative review
Barimbing, M. L., Jeger, D. P., & Sridana, M. E. (2025) · Progress in Palliative Care · doi:10.1080/09699260.2026.2657096
Psychosocial Interventions for Chronic Non-Cancer Pain Among Older Adults: A Scoping Review
Low, E. L., Gibson, S. L., Patel, K. B., Hickner, A., Sanni, M., Scher, C. J., & Reid, M. C. (2026) · Journal of Applied Gerontology · doi:10.1177/07334648261462221
- Authors
- Riecke, J., Rief, W., Lemmer, G., & Glombiewski, J. A.
- Affiliations
- Philipps University of Marburg (DE)
- University of Koblenz and Landau (DE)
- Corresponding author
- Riecke, Jenny
- Venue
- European Journal of Pain
- Publisher
- Wiley
- Published
- 2023-07-20
- Volume
- 28
- Issue
- 1
- Pages
- 83-94
- ISSN
- 1090-3801 (ISSN-L)
- 1532-2149
- OpenAlex
- W4384819730
- Cited by
- 15
- References
- 55
- Citations by year
- 2026: 1 · 2025: 8 · 2024: 5 · 2023: 1
- FWCI
- 2.34
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Licence
- Locations
- European Journal of Pain (publishedVersion, cc-by)
- PubMed (publishedVersion)
- Funders
- Deutsche Forschungsgemeinschaft
- Topics
- Health Sciences › Medicine › Pharmacology › Musculoskeletal pain and rehabilitation
- Health Sciences › Medicine › Anesthesiology and Pain Medicine › Pain Management and Treatment
- Social Sciences › Psychology › Clinical Psychology › Psychotherapy Techniques and Applications
- Keywords
- chronic low back pain, cognitive behavioral therapy, in vivo exposure, long-term treatment outcomes, treatment sustainability, fear-avoidance beliefs, pain-related disability, pain intensity, emotional distress, psychological flexibility, pain catastrophizing, fear of pain, dropout
- MeSH terms
- Back Pain, Cognition, Follow-Up Studies, Humans, Phobic Disorders, Cognitive Behavioral Therapy, Chronic Pain
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
Are you an author, or do you see a problem with this page? Request a review
