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Clinical Journal of Pain:
doi: 10.1097/AJP.0000000000000138
Original Articles

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

Van der Maas, Lia C.C. MSc*†‡§; Köke, Albère PhD; Pont, Menno MD; Bosscher, Ruud J. PhD; Twisk, Jos W.R. PhD#**; Janssen, Thomas W.J. PhD‡§; Peters, Madelon L. PhD††

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Background: Because of methodological flaws and a lack of theoretical foundation of body awareness (BA) in previous effect studies of interventions directed to stimulate BA, it is impossible to attribute treatment effects to this specific component of a multidisciplinary treatment. Therefore, this study evaluated short-term and long-term effects of a multidisciplinary pain rehabilitation program with and without psychomotor therapy (PMT), which focused on BA (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 PMT. Outcome variables were health-related quality of life, disability, and depression. BA, catastrophizing, and self-efficacy were measured as potential process variables. Assessments were performed at baseline, directly after treatment, and at 3, 6, and 12 month follow-ups. The data were analyzed 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 favoring PMT were found between conditions on depression (regression coefficient [RC]=−5.01; 95% confidence interval [CI], −8.81 to −1.21), BA (RC=0.23; 95% CI, 0.04 to 0.42) and catastrophizing (RC=−4.76; 95% CI, −8.03 to −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 health-related quality of life and disability. However, this is the first long-term RCT that has shown that PMT improves BA in patients with chronic pain and shows good effect size and a significant decrease for catastrophizing.

Copyright © 2015 Wolters Kluwer Health, Inc. All rights reserved.

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