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F661 STAYING AT WORK WITH CHRONIC MUSCULOSKELETAL PAIN: A NEW REFERENCE FOR PAIN REHABILITATION
186
POSTER SESSIONS / European Journal of Pain Supplements 5 (2011) 15–295
F658 PRELIMINARY OUTCOMES FROM AN ABBREVIATED INTERDISCIPLINARY PROGRAMME OF ACCEPTANCE AND COMMITMENT THERAPY FOR PATIENTS WITH CHRONIC PAIN G. Sowden1,2 *, K. Vowles1,2 , D. Beachill1 , N. Stanyer1 , J. Ashworth1,2 , J. Packham1,2 . 1 Interdisciplinary Musculoskeletal Pain Assessment and Community Treatment Service, Haywood Hospital, Stoke-on-Trent, 2 Arthritis Research UK Primary Care Centre, Primary Care Sciences, Keele University, Keele, UK
have developed algorithms for chronic pain treatment in different pathologies with regard to intensity and duration of pain. In our work we use different methods of treatment based on traditional and official medicine. Results: More than 100 thousand patients were successfully treated, there were defended more than 10 theses, several monographs were written, a sufficient number of specialists were trained to be able to work with patients with chronic pain. Today active researches and clinical work are underway.
Background and Aims: Chronic pain poses a significant burden to the individual sufferer, society and the health care system. Intensive group-based interdisciplinary pain rehabilitation programmes using Acceptance and Commitment Therapy (ACT) have demonstrated promising results, however, not all services have the resources to deliver this intensity of programme. This study therefore evaluates. a. the clinical outcomes and b. health care utilisation following an abbreviated interdisciplinary pain rehabilitation programme offered in a community hospital setting. Methods: Data was collected from 60 patients with chronic pain who completed the programme (seven hours of treatment per day, two days per week for four weeks). Outcomes included measures of physical and psychosocial functioning and pain-related healthcare visits and frequency of interventions for pain. Outcomes were assessed immediately following treatment and at 3 month and 12 month follow-ups. Results: There were significant reductions in overall physical and psychosocial disability (effect size 0.65 and 1.0, respectively) and emotional functioning (effect size – depression: 0.98; pain-related fear: 0.82) immediately following programme. There was good maintenance of treatment gains at 3 and 12 months. Pain-related healthcare visits were significantly reduced at 3 and 12 months follow-ups (effect size 0.69). Secondary analysis suggests that the most physically disabled patients (low pre-programme walking physical performance) did less well post programme and at followups. Conclusions: These data suggest that an abbreviated ACT programme shows good treatment effectiveness even through longer-term follow-ups for the majority of patients. The most physically disabled patients, however, may require more intensive treatment.
Disclosure: None declared
Disclosure: None declared
Disclosure: None declared
F659 MULTIDISCIPLINARY APPROACH IN PAIN TREATMENT IN RUSSIA O. Zagorulko1 *, A. Gnezdilov2 , N. Samoylova2 , L. Medvedeva2 . 1 National Research Center of Surgery Russian Academy of Medical Science, 2 Pain Treatment, National Research Center of Surgery Russian Academy of Medical Science, Moscow, Russia
F661 STAYING AT WORK WITH CHRONIC MUSCULOSKELETAL PAIN: A NEW REFERENCE FOR PAIN REHABILITATION H.J. de Vries1 *, S. Brouwer2 , J.W. Groothoff2 , J.H.B. Geertzen1 , M.F. Reneman1 . 1 Department of Rehabilitation Medicine, 2 Department of Health Sciences, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
Background: The structure of centers and clinics for pain treatment in Russia varies. We attempted to integrate all the existing methods of acute and chronic pain treatment. Methods: The Department of pain syndromes was organized for the first time in Russia in 1976 on the basis of anesthesiology. At first the work of the department was aimed at studying various types of drug-free anesthesia, the scientific rationale for the causes and long-term duration of pain syndrome and determination of possible methods of its treatment. Originally the department staff consisted of anesthesiologists, physiologists, and neurologists. The department expanded gradually. There was a need to involve doctors of other specialties: traumatologists, psychologists, reflexologists, physiotherapists, masseurs, physical training doctors. Studying the causes of chronic pain syndrome development, its duration and possible ways of its treatment it became clear to us that the problem was complex and that it should be solved by the efforts of a wide range of specialists. We
F660 EFFECTIVENESS AND COST-EFFECTIVENESS OF SHORTENING REHABILITATION PROGRAMS FOR PATIENTS WITH CHRONIC MUSCULOSKELETAL PAIN; DESIGN OF A RCT F.P.C. Waterschoot *, J.H.B. Geertzen, P.U. Dijkstra, M.F. Reneman. Department of Rehabilitation Medicine, University Medical Center Groningen, Groningen, The Netherlands Background and Aims: Pain Rehabilitation Programs (PRP’s) are proven effective for patients with chronic musculoskeletal pain (CMP). Evidence about the relationship of dose on the effect of PRP however, is unavailable. We hypothesized that shortening PRP will not be inferior to care as usual. The aim of the RCT is to analyse the effect of shortening duration of PRP on effectiveness and cost effectiveness of PRP. Methods: The study will be a single blind, 2 armed, randomized controlled clinical trial, with a non inferiority design. A total of 264 patients with CMP referred to outpatient multidisciplinary PRP will be included for the study. The control intervention will be care as usual. Three programs will be applied with durations of 12, 16 or 20 weeks, depending on the complexity The experimental group will receive PRP in 4 weeks less than care as usual, while the experimental intervention will not differ in content. Pain related disability, measured with the Pain Disability Index (PDI), will be the main outcome. The non-inferiority margin is predefined as 4 points difference on PDI to tolerate as non-inferior. For cost-effectiveness direct and indirect costs will be calculated. Patients will complete questionnaires at baseline, end of PRP and at 3 and 12 months follow up. Inclusion: 2 years starting September 2011. Results: Not available. Conclusions: This will be the first RCT ever in the PRP field to study dose variables.
Background and Aims: Chronic nonspecific musculoskeletal pain (CMP) results often in work disability and sick-leave, confronting employers, insurance companies, and society with considerable costs. However, a substantial amount of workers stay at work despite CMP. It is currently unknown on which factors people who stay at work despite CMP differ from those who do not. Attention to workers who stay at work despite CMP will enlarge our understanding of work participation in people with CMP. The main question of this study was: what are the characteristics of workers who manage to stay at work despite CMP, and what can be learned from this successful group? Methods: Cross-sectional design. Medical, physical, psychological and social variables of workers who stay at work with CMP were described (n = 120), and compared with sick-listed workers with CMP who sought multidisciplinary pain rehabilitation care (n = 120).
POSTER SESSIONS / European Journal of Pain Supplements 5 (2011) 15–295
Results: Relevant differences were observed on pain disability, physical and mental health, lifting low, static overhead work, forward bending, pain catastrophizing, pain self-efficacy, work satisfaction and presenteeism. Non-relevant differences were observed on pain intensity, activity level, dynamic bending, pain acceptance, fear avoidance, psycho-neuroticism, pain coping, responses of significant others, need for recovery, and work demands. Conclusions: Relevant and non-relevant differences exist between workers with CMP who stay at work and sick-listed workers who search pain rehabilitation. The results of this study can be used to develop interventions to promote staying at work. The knowledge gathered in this study provides a new reference for clinicians working in rehabilitation, occupational, and insurance medicine. Disclosure: None declared
F662 CHRONIC PAIN IN TRANSCULTURAL PERSPECTIVE – A COMPREHENSIVE PSYCHOSOMATIC REHABILITATION PROGRAM IN THE NETHERLANDS FOR WOMEN WITH A TURKISH BACKGROUND J.L. Swaan1 *, L. Bamburac2 . 1 PBA-2, Rijndam Revalidatiecentrum, 2 Transculturele Hulpverlening, Riagg Rijnmond, Rotterdam, The Netherlands Background and Aims: Regular pain management programmes are not suitable for transcultural patients with aspecific chronic pain. In primary care and in mental health facilities and in rehabilitation centres there is an increasing prevalence of medically unexplained symptoms such as chronic aspecific pain in the migrant population. In cooperation with Riagg Rijnmond Outpatient Psychiatric Services, a program was developed to increase their level of functioning at home (cooking, cleaning, childcare) and in the community (social activities, work). Methods: Patients participated in a 2 days weekly bilangual cognitive-behavioural treatment program in different groups during 10 weeks, consisting of pain education, psychological education, physical training, relaxation therapy, goal setting and autonomy. Patients were treated by a team consisting of rehabilitation specialists and psychiatry specialists. Results: Since 2008 we included 54 women, mean age 45.3 years old. Eighteen patients did not start due to different reasons. Thirty-six patients participated in 4 groups. Twenty-four patients completed the treatment (1 dropped out twice). All but one were first generation Turkish immigrants. Medical diagnosis: generalized pain (24), cervicobrachialgic syndrome (10), back pain (7), other pain disorder (8), unknown (5). Psychiatric diagnosis: depression (26), anxiety disorder (10), adjustment disorder (10), personality disorder (9) and other diagnoses (7). Some patients had multiple disorders. After treatment most patients were satisfied and became more active. Painrates remained unchanged. Conclusions: For patients with multiple medical, psychological and social problems who complete the treatment, this program seems to be effective. Insufficient motivation and commitment with selfmanagement is the main reason for dropout. Disclosure: None declared
F663 DIAGNOSTIC DIFFICULTIES AND THERAPY OF PAIN ASSOCIATED WITH SYSTEMIC LUPUS ERYTHEMATOSUS (CASE REPORT) L. Navratil1 *, D. Bludovsky1 , J. Lejcko2 . 1 Dept. of Neurosurgery, 2 Dept. of Pain Therapy of Clinic of Anesthesiology and Resuscitation, Teaching Hospital of Charles University, Plzen, Czech Republic Background and Aims: Pain associated with systemic lupus erythematosus (SLE) is nociceptive and/or neuropathic and may be secondary to the disease itself or to the complications of chronic therapy. Methods: Case report
187
Results: Woman, 65, with history of 15 years corticoid treatment of SLE. SLE led to glomerulonefritis, polyarthritis, pleuritis, and corticoid treatment resulted in osteoporosis. In April 2009, sciatica in right L5 dermatome started (confimed by EMG). Drug treatment was not effective. MRI showed slightly thicker right L5 root. Check-up confirmed periradicular fibrosis. Punctional periradicular therapy was successful. After pulsed radiofrequency therapy (PRTF) pain disappeared and has never come back. In November 2010 another pain suddenly started in interscapular area. Only painkillers were administered. In January 2011 epigastric pain arose, patient couldn’t walk and developed urinal retention. Abdominal CT imaging drew all attention to a small suspected tumor in bladder. Urothelial hyperplasy was removed endoscopically. The patient came to our outpatients’ clinic in March 2011. We found central paraparesis with hypoestesia below T6 level. NMR and CT exams confirmed spinal cord compression due to the osteoporotic fracture of T6 vertebral body. After decompression and fixation retention and pain disappeared completely, walking is getting better. Conclusions: (1) Neuropathic pain in L5 dermatoma was probably caused by periradicular fibrosis secondary to SLE. PRFT of L5 root has had excellent results. (2) Interscapular pain and consequent epigastric pain were misjudged as well as paraparesis and urinal retention. Our clinical exam led to a correct diagnosis and relevant surgical treatment. Disclosure: None declared
F664 ACCEPTANCE AND CATASTROPHIZING IN CHRONIC PAIN PATIENTS IN THE THERAPEUTIC PROCESS AND THEIR INFLUENCE ON THE OUTCOME – INTERIM ANALYSIS U. Kaiser *, F. Balck, R. Sabatowski. Universit¨ atsklinikum Dresden, Dresden, Germany Background and Aims: Chronification of pain occurs within different neurophysiologic as well as on psychosocial levels. Among the psychosocial concepts of chronification the fear-avoidancemodel, the concept of pain acceptancy and the concept of catastrophizing were among the most promising models. In this study we investigated the role of these models in the therapeutic process of a multimodal pain therapy and their impact on outcome parameters. Methods: 60 patients of a multimodal pain clinic were investigated by the following variables: Independent Variables: Fear Avoidance (FABQ), Acceptance and Willingness to Pain (CPAQ), Painrelated Catastrophizing (PCS) Dependent Variables/Outcome: Pain Intensity (NRS), Quality of Life (SF 36), Pain related disability (PDI). Moderator/Mediator Variables: Depression (BSI), General anxiety (BSI), General psychological distress (BSI), Spouses response to pain and well behaviour (SRI). Data collection was performed at baseline (T1), at the end of therapy (T2), after booster week 3 month after T2 (T3) and after 6 month after T3 (T4). Analysis: correlation, path analysis and nonparametric analysis to identify the relations between the variables and identify path coefficients. All calculations will be done by SPSS 16.0. Results: The relations between the variables will be presented in path models. Conclusions: It seems to be important to consider variables like depression and anxiety as mediator variables. All three concepts have proven to be considerable for prediction of therapy outcome but only in addiction to most of the mediator variables. Disclosure: None declared
POSTER SESSIONS / European Journal of Pain Supplements 5 (2011) 15–295
F658 PRELIMINARY OUTCOMES FROM AN ABBREVIATED INTERDISCIPLINARY PROGRAMME OF ACCEPTANCE AND COMMITMENT THERAPY FOR PATIENTS WITH CHRONIC PAIN G. Sowden1,2 *, K. Vowles1,2 , D. Beachill1 , N. Stanyer1 , J. Ashworth1,2 , J. Packham1,2 . 1 Interdisciplinary Musculoskeletal Pain Assessment and Community Treatment Service, Haywood Hospital, Stoke-on-Trent, 2 Arthritis Research UK Primary Care Centre, Primary Care Sciences, Keele University, Keele, UK
have developed algorithms for chronic pain treatment in different pathologies with regard to intensity and duration of pain. In our work we use different methods of treatment based on traditional and official medicine. Results: More than 100 thousand patients were successfully treated, there were defended more than 10 theses, several monographs were written, a sufficient number of specialists were trained to be able to work with patients with chronic pain. Today active researches and clinical work are underway.
Background and Aims: Chronic pain poses a significant burden to the individual sufferer, society and the health care system. Intensive group-based interdisciplinary pain rehabilitation programmes using Acceptance and Commitment Therapy (ACT) have demonstrated promising results, however, not all services have the resources to deliver this intensity of programme. This study therefore evaluates. a. the clinical outcomes and b. health care utilisation following an abbreviated interdisciplinary pain rehabilitation programme offered in a community hospital setting. Methods: Data was collected from 60 patients with chronic pain who completed the programme (seven hours of treatment per day, two days per week for four weeks). Outcomes included measures of physical and psychosocial functioning and pain-related healthcare visits and frequency of interventions for pain. Outcomes were assessed immediately following treatment and at 3 month and 12 month follow-ups. Results: There were significant reductions in overall physical and psychosocial disability (effect size 0.65 and 1.0, respectively) and emotional functioning (effect size – depression: 0.98; pain-related fear: 0.82) immediately following programme. There was good maintenance of treatment gains at 3 and 12 months. Pain-related healthcare visits were significantly reduced at 3 and 12 months follow-ups (effect size 0.69). Secondary analysis suggests that the most physically disabled patients (low pre-programme walking physical performance) did less well post programme and at followups. Conclusions: These data suggest that an abbreviated ACT programme shows good treatment effectiveness even through longer-term follow-ups for the majority of patients. The most physically disabled patients, however, may require more intensive treatment.
Disclosure: None declared
Disclosure: None declared
Disclosure: None declared
F659 MULTIDISCIPLINARY APPROACH IN PAIN TREATMENT IN RUSSIA O. Zagorulko1 *, A. Gnezdilov2 , N. Samoylova2 , L. Medvedeva2 . 1 National Research Center of Surgery Russian Academy of Medical Science, 2 Pain Treatment, National Research Center of Surgery Russian Academy of Medical Science, Moscow, Russia
F661 STAYING AT WORK WITH CHRONIC MUSCULOSKELETAL PAIN: A NEW REFERENCE FOR PAIN REHABILITATION H.J. de Vries1 *, S. Brouwer2 , J.W. Groothoff2 , J.H.B. Geertzen1 , M.F. Reneman1 . 1 Department of Rehabilitation Medicine, 2 Department of Health Sciences, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
Background: The structure of centers and clinics for pain treatment in Russia varies. We attempted to integrate all the existing methods of acute and chronic pain treatment. Methods: The Department of pain syndromes was organized for the first time in Russia in 1976 on the basis of anesthesiology. At first the work of the department was aimed at studying various types of drug-free anesthesia, the scientific rationale for the causes and long-term duration of pain syndrome and determination of possible methods of its treatment. Originally the department staff consisted of anesthesiologists, physiologists, and neurologists. The department expanded gradually. There was a need to involve doctors of other specialties: traumatologists, psychologists, reflexologists, physiotherapists, masseurs, physical training doctors. Studying the causes of chronic pain syndrome development, its duration and possible ways of its treatment it became clear to us that the problem was complex and that it should be solved by the efforts of a wide range of specialists. We
F660 EFFECTIVENESS AND COST-EFFECTIVENESS OF SHORTENING REHABILITATION PROGRAMS FOR PATIENTS WITH CHRONIC MUSCULOSKELETAL PAIN; DESIGN OF A RCT F.P.C. Waterschoot *, J.H.B. Geertzen, P.U. Dijkstra, M.F. Reneman. Department of Rehabilitation Medicine, University Medical Center Groningen, Groningen, The Netherlands Background and Aims: Pain Rehabilitation Programs (PRP’s) are proven effective for patients with chronic musculoskeletal pain (CMP). Evidence about the relationship of dose on the effect of PRP however, is unavailable. We hypothesized that shortening PRP will not be inferior to care as usual. The aim of the RCT is to analyse the effect of shortening duration of PRP on effectiveness and cost effectiveness of PRP. Methods: The study will be a single blind, 2 armed, randomized controlled clinical trial, with a non inferiority design. A total of 264 patients with CMP referred to outpatient multidisciplinary PRP will be included for the study. The control intervention will be care as usual. Three programs will be applied with durations of 12, 16 or 20 weeks, depending on the complexity The experimental group will receive PRP in 4 weeks less than care as usual, while the experimental intervention will not differ in content. Pain related disability, measured with the Pain Disability Index (PDI), will be the main outcome. The non-inferiority margin is predefined as 4 points difference on PDI to tolerate as non-inferior. For cost-effectiveness direct and indirect costs will be calculated. Patients will complete questionnaires at baseline, end of PRP and at 3 and 12 months follow up. Inclusion: 2 years starting September 2011. Results: Not available. Conclusions: This will be the first RCT ever in the PRP field to study dose variables.
Background and Aims: Chronic nonspecific musculoskeletal pain (CMP) results often in work disability and sick-leave, confronting employers, insurance companies, and society with considerable costs. However, a substantial amount of workers stay at work despite CMP. It is currently unknown on which factors people who stay at work despite CMP differ from those who do not. Attention to workers who stay at work despite CMP will enlarge our understanding of work participation in people with CMP. The main question of this study was: what are the characteristics of workers who manage to stay at work despite CMP, and what can be learned from this successful group? Methods: Cross-sectional design. Medical, physical, psychological and social variables of workers who stay at work with CMP were described (n = 120), and compared with sick-listed workers with CMP who sought multidisciplinary pain rehabilitation care (n = 120).
POSTER SESSIONS / European Journal of Pain Supplements 5 (2011) 15–295
Results: Relevant differences were observed on pain disability, physical and mental health, lifting low, static overhead work, forward bending, pain catastrophizing, pain self-efficacy, work satisfaction and presenteeism. Non-relevant differences were observed on pain intensity, activity level, dynamic bending, pain acceptance, fear avoidance, psycho-neuroticism, pain coping, responses of significant others, need for recovery, and work demands. Conclusions: Relevant and non-relevant differences exist between workers with CMP who stay at work and sick-listed workers who search pain rehabilitation. The results of this study can be used to develop interventions to promote staying at work. The knowledge gathered in this study provides a new reference for clinicians working in rehabilitation, occupational, and insurance medicine. Disclosure: None declared
F662 CHRONIC PAIN IN TRANSCULTURAL PERSPECTIVE – A COMPREHENSIVE PSYCHOSOMATIC REHABILITATION PROGRAM IN THE NETHERLANDS FOR WOMEN WITH A TURKISH BACKGROUND J.L. Swaan1 *, L. Bamburac2 . 1 PBA-2, Rijndam Revalidatiecentrum, 2 Transculturele Hulpverlening, Riagg Rijnmond, Rotterdam, The Netherlands Background and Aims: Regular pain management programmes are not suitable for transcultural patients with aspecific chronic pain. In primary care and in mental health facilities and in rehabilitation centres there is an increasing prevalence of medically unexplained symptoms such as chronic aspecific pain in the migrant population. In cooperation with Riagg Rijnmond Outpatient Psychiatric Services, a program was developed to increase their level of functioning at home (cooking, cleaning, childcare) and in the community (social activities, work). Methods: Patients participated in a 2 days weekly bilangual cognitive-behavioural treatment program in different groups during 10 weeks, consisting of pain education, psychological education, physical training, relaxation therapy, goal setting and autonomy. Patients were treated by a team consisting of rehabilitation specialists and psychiatry specialists. Results: Since 2008 we included 54 women, mean age 45.3 years old. Eighteen patients did not start due to different reasons. Thirty-six patients participated in 4 groups. Twenty-four patients completed the treatment (1 dropped out twice). All but one were first generation Turkish immigrants. Medical diagnosis: generalized pain (24), cervicobrachialgic syndrome (10), back pain (7), other pain disorder (8), unknown (5). Psychiatric diagnosis: depression (26), anxiety disorder (10), adjustment disorder (10), personality disorder (9) and other diagnoses (7). Some patients had multiple disorders. After treatment most patients were satisfied and became more active. Painrates remained unchanged. Conclusions: For patients with multiple medical, psychological and social problems who complete the treatment, this program seems to be effective. Insufficient motivation and commitment with selfmanagement is the main reason for dropout. Disclosure: None declared
F663 DIAGNOSTIC DIFFICULTIES AND THERAPY OF PAIN ASSOCIATED WITH SYSTEMIC LUPUS ERYTHEMATOSUS (CASE REPORT) L. Navratil1 *, D. Bludovsky1 , J. Lejcko2 . 1 Dept. of Neurosurgery, 2 Dept. of Pain Therapy of Clinic of Anesthesiology and Resuscitation, Teaching Hospital of Charles University, Plzen, Czech Republic Background and Aims: Pain associated with systemic lupus erythematosus (SLE) is nociceptive and/or neuropathic and may be secondary to the disease itself or to the complications of chronic therapy. Methods: Case report
187
Results: Woman, 65, with history of 15 years corticoid treatment of SLE. SLE led to glomerulonefritis, polyarthritis, pleuritis, and corticoid treatment resulted in osteoporosis. In April 2009, sciatica in right L5 dermatome started (confimed by EMG). Drug treatment was not effective. MRI showed slightly thicker right L5 root. Check-up confirmed periradicular fibrosis. Punctional periradicular therapy was successful. After pulsed radiofrequency therapy (PRTF) pain disappeared and has never come back. In November 2010 another pain suddenly started in interscapular area. Only painkillers were administered. In January 2011 epigastric pain arose, patient couldn’t walk and developed urinal retention. Abdominal CT imaging drew all attention to a small suspected tumor in bladder. Urothelial hyperplasy was removed endoscopically. The patient came to our outpatients’ clinic in March 2011. We found central paraparesis with hypoestesia below T6 level. NMR and CT exams confirmed spinal cord compression due to the osteoporotic fracture of T6 vertebral body. After decompression and fixation retention and pain disappeared completely, walking is getting better. Conclusions: (1) Neuropathic pain in L5 dermatoma was probably caused by periradicular fibrosis secondary to SLE. PRFT of L5 root has had excellent results. (2) Interscapular pain and consequent epigastric pain were misjudged as well as paraparesis and urinal retention. Our clinical exam led to a correct diagnosis and relevant surgical treatment. Disclosure: None declared
F664 ACCEPTANCE AND CATASTROPHIZING IN CHRONIC PAIN PATIENTS IN THE THERAPEUTIC PROCESS AND THEIR INFLUENCE ON THE OUTCOME – INTERIM ANALYSIS U. Kaiser *, F. Balck, R. Sabatowski. Universit¨ atsklinikum Dresden, Dresden, Germany Background and Aims: Chronification of pain occurs within different neurophysiologic as well as on psychosocial levels. Among the psychosocial concepts of chronification the fear-avoidancemodel, the concept of pain acceptancy and the concept of catastrophizing were among the most promising models. In this study we investigated the role of these models in the therapeutic process of a multimodal pain therapy and their impact on outcome parameters. Methods: 60 patients of a multimodal pain clinic were investigated by the following variables: Independent Variables: Fear Avoidance (FABQ), Acceptance and Willingness to Pain (CPAQ), Painrelated Catastrophizing (PCS) Dependent Variables/Outcome: Pain Intensity (NRS), Quality of Life (SF 36), Pain related disability (PDI). Moderator/Mediator Variables: Depression (BSI), General anxiety (BSI), General psychological distress (BSI), Spouses response to pain and well behaviour (SRI). Data collection was performed at baseline (T1), at the end of therapy (T2), after booster week 3 month after T2 (T3) and after 6 month after T3 (T4). Analysis: correlation, path analysis and nonparametric analysis to identify the relations between the variables and identify path coefficients. All calculations will be done by SPSS 16.0. Results: The relations between the variables will be presented in path models. Conclusions: It seems to be important to consider variables like depression and anxiety as mediator variables. All three concepts have proven to be considerable for prediction of therapy outcome but only in addiction to most of the mediator variables. Disclosure: None declared