A randomized trial of a cognitive-behavioral program for enhancing back pain self care in a primary care setting.
Abstract
Back pain is a significant health care problem that has been managed unsatisfactorily in primary care settings. Providers typically address medical issues but do not adequately address patient concerns or functional limitations related to back pain. We evaluated a brief intervention for primary care back pain patients designed to provide accurate information about back pain, instill attitudes favorable towards self care, reduce fears and worries, assist patients in developing personalized action plans to manage their back pain, and improve functional outcomes. Patients enrolled in a large health maintenance organization were invited to participate in an educational program to improve back pain self care skills 6-8 weeks after a primary care back pain visit. Patients (n=226) were randomly assigned to a Self Care intervention or to Usual Care, and were assessed at baseline, 3-, 6-, and 12-months. The intervention involved a two-session Self Care group and an individual meeting and telephone conversation with the group leader, a psychologist experienced in chronic pain management. The intervention was supplemented by educational materials (book and videos) supporting active management of back pain. The control group received usual care supplemented by a book on back pain care. Participants assigned to the Self Care intervention showed significantly greater reductions in back-related worry and fear-avoidance beliefs than the control group. Modest, but statistically significant, effects on pain ratings and interference with activities were also observed.
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- Authors
- Moore, J. E., Von Korff, M., Cherkin, D., Saunders, K., & Lorig, K.
- Affiliations
- Group Health Cooperative (US)
- Stanford Medicine (US)
- Corresponding author
- Moore, James E.
- ORCID
- Lorig, Kate
- Venue
- Pain
- Published
- 2000-11
- Volume
- 88
- Issue
- 2
- Pages
- 145-153
- ISSN
- 0304-3959 (ISSN-L)
- OpenAlex
- W2025314877
- Cited by
- 252
- References
- 51
- Citations by year
- 2026: 1 · 2025: 1 · 2024: 1 · 2023: 2 · 2022: 4 · 2021: 11 · 2020: 6 · 2019: 11 · 2018: 6 · 2017: 7 · 2016: 9 · 2015: 9 · 2014: 8 · 2013: 10 · 2012: 8
- FWCI
- 6.47
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Pain (publishedVersion)
- PubMed (publishedVersion)
- Funders
- Boeing
- National Institutes of Health
- National Institute of Dental and Craniofacial Research (P01 DE08773, P01DE008773)
- Topics
- Health Sciences › Medicine › Pharmacology › Musculoskeletal pain and rehabilitation
- Health Sciences › Medicine › Anesthesiology and Pain Medicine › Pain Management and Treatment
- Health Sciences › Medicine › Pediatrics, Perinatology and Child Health › Pediatric Pain Management Techniques
- Keywords
- back pain, self-care, cognitive-behavioral intervention, primary care, fear-avoidance beliefs, chronic pain management, functional outcome, health maintenance organizations, patient education
- MeSH terms
- Adult, Aged, Attitude, Back Pain, Disability Evaluation, Fear, Female, Humans, Male, Mental Health, Middle Aged, Pain Measurement, Primary Health Care, Self Care, Cognitive Behavioral Therapy, Treatment Outcome
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