Catastrophizing and internal pain control as mediators of outcome in the multidisciplinary treatment of chronic low back pain
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The aim of the present study was to examine (a) whether a cognitive-behavioral treatment (differentially) affects pain coping and cognition; and (b) whether changes in pain coping and cognition during treatment mediate treatment outcome. Participants in this randomized clinical trial were 148 patients with chronic low back pain attending a multidisciplinary treatment program consisting of operant-behavioral treatment plus cognitive coping skills training (N = 59) or group discussion (N = 58) or allocated to a waiting list control condition (N = 31). Patients improved with respect to level of depression, pain behavior and activity tolerance at posttreatment and 12-month follow-up. Treatment also resulted in a short- and long-term decrease in catastrophizing and an enhancement of internal pain control. Changes in catastrophizing and to a lesser degree in internal pain control mediated the reduction in level of depression and pain behavior following treatment. The use of behavioral and cognitive interventions aimed at decreasing catastrophizing thoughts about the consequences of pain and promoting internal expectations of pain control possibly constitute an important avenue of change irrespective of the type of treatment.
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Relatively few treatment outcome studies have undertaken to measure and analyse possible mediators or change processes in chronic pain trials.
“In fact, relatively few treatment outcome studies have undertaken to measure and analyse possible mediators 50, 51, 57 or changes processes 4-6, 19, 20, 45, 46 in chronic pain trials.”
From The Mediating Role of Acceptance in Multidisciplinary Cognitive-Behavioral Therapy for Chronic Pain (2015) · cites this paper as [46]
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- Authors
- Spinhoven, P., ter Kuile, M., Kole‐Snijders, A. M. J., Mansfeld, M. H., den Ouden, D., & Vlaeyen, J. W. S.
- Affiliations
- Leiden University (NL)
- Maastricht University Medical Centre (NL)
- Corresponding author
- Spinhoven, Philip
- Venue
- European Journal of Pain
- Publisher
- Wiley
- Published
- 2004-06
- Volume
- 8
- Issue
- 3
- Pages
- 211-219
- ISSN
- 1090-3801 (ISSN-L)
- 1532-2149
- OpenAlex
- W1988974431
- Cited by
- 274
- References
- 28
- Citations by year
- 2026: 4 · 2025: 2 · 2024: 7 · 2023: 6 · 2022: 8 · 2021: 15 · 2020: 11 · 2019: 14 · 2018: 13 · 2017: 20 · 2016: 17 · 2015: 14 · 2014: 11 · 2013: 16 · 2012: 20
- FWCI
- 5.36
- Type
- journal article
- Language
- en
- Open access
- green
- www.nivel.nl
- Licence
- Locations
- European Journal of Pain (publishedVersion)
- PubMed (publishedVersion)
- Data Archiving and Networked Services (DANS) (submittedVersion, other-oa)
- Topics
- Health Sciences › Medicine › Pharmacology › Musculoskeletal pain and rehabilitation
- Health Sciences › Medicine › Anesthesiology and Pain Medicine › Pain Management and Treatment
- Life Sciences › Neuroscience › Cognitive Neuroscience › Pain Management and Placebo Effect
- Keywords
- chronic low back pain, catastrophizing, pain coping, cognitive behavioral therapy, multidisciplinary pain management, mediation, depression, pain behavior, activity tolerance, coping skills training
- MeSH terms
- Adaptation, Psychological, Adolescent, Adult, Anxiety, Chronic Disease, Cognition, Depression, Female, Humans, Male, Middle Aged, Patient Compliance, Cognitive Behavioral Therapy, Treatment Outcome, Low Back Pain, Recovery of Function
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