Behavioral Management of Chronic Pain and Excess Disability: Long-Term Follow-Up of an Outpatient Program

OBJECTIVETo assess the overall efficiency of an outpatient behavioral rehabilitation program for excess disability and chronic pain and to describe the program staff, treatment components and outcomes in sufficient detail to facilitate comparison with similar programs. DESIGNEight-year follow-up study of patients referred and treated. SETTINGOutpatient primary care and multispecialty group medical practice. PATIENTS354 of 421 unselected patients referred for the behavioral management of excess disability, who completed the treatment program and participated in follow-up. INTERVENTIONS15–20 sessions of physical and occupational therapy, 5–10 sessions of biofeedback, and one or two family sessions all based upon behavioral techniques described by Fordyce and by Roberts. MAIN OUTCOME MEASURESQuestionnaires, including analog scales, administered before treatment and at 1, 6, 12, and 24 months posttreatment. RESULTSPatients (n = 67) who dropped out did not differ systematically from those who participated (n = 354). The treatment program resulted in a marked and enduring reduction of pain, and a statistically and clinically significant improvement in patientsʼ ability to function at work and in the home. Patients overwhelmingly endorsed the program. CONCLUSIONSA brief, inexpensive, outpatient behavioral rehabilitation program for chronic pain and excess disability can achieve a clinically significant and lasting reduction of pain and improvement in function at work and at home.