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Clinical Journal of Pain:
doi: 10.1097/AJP.0000000000000138
Original Article: PDF Only

Improving the Multidisciplinary Treatment of Chronic Pain by Stimulating Body Awareness: A Cluster-randomized Trial.

van der Maas, Lia C.C. MSc; Köke, Albère MD; Pont, Menno; Bosscher, Ruud J.; Twisk, Jos W.R.; Janssen, Thomas W.J.; Peters, Madelon L.

Published Ahead-of-Print
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Background: Due to methodological flaws and a lack of theoretical foundation of body awareness in previous effect studies of interventions directed to stimulate body awareness, it is impossible to attribute treatment effects to this specific component of a multidisciplinary treatment. Therefore, this study evaluates short-term and long-term effects of a multidisciplinary pain rehabilitation program with and without psychomotor therapy (PMT), which focuses on body awareness (measured by the Scale of Body Connection) as a primary target of intervention.

Methods: Ninety-four patients clustered in 20 treatment groups were cluster-randomized, using a biased-coin design, to multidisciplinary treatment as usual with or without psychomotor therapy. Outcome variables were health related quality of life, disability and depression. Body awareness, catastrophizing, and self-efficacy were measured as potential process variables. Assessments were performed at baseline, directly after treatment, and at 3, 6 and 12 months follow-up. The data were analysed by linear mixed model analysis according to the intention-to-treat principle.

Results: Data of all 94 patients were used for analyses. After treatment, significant differences favouring PMT were found between conditions on depression (RC=-5.01; 95% CI=-8.81; -1.21), body awareness (RC=0.23; 95% CI=0.04; 0.42) and catastrophizing (RC=-4.76; 95% CI=-8.03; -1.48). These differences were no longer significant for depression at the 3-month follow-up and for catastrophizing at the 6-month follow-up.

Conclusions: No clinical meaningful differences were found between treatment conditions in the primary outcome measures HRQOL and disability. However, this is the first long term RCT that has shown that Psychomotor Therapy improves body awareness in patients with chronic pain and shows good effect size and a significant decrease for catastrophizing.

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