Studies show that a multidisciplinary approach is best for patients with chronic low back pain (LBP). Multidisciplinary involves physiotherapy, behavioral and psychologic counseling, and change in psychosocial factors. A chronic stage is defined as patients with pain lasting three months or more.

But does length of time in the chronic stage matter? Can anyone (no matter how long they have had LBP) benefit from this type of treatment? That's the question researchers in Germany asked in this study.

They divided 387 patients with chronic LBP into three groups. The groups were based on length of time symptoms were present. All patients had pain for more than three months. They also had all been on sick leave for at least six weeks. Each patient had been treated with conservative (nonoperative) therapy without success.

There were four chronicity grades included. Each grade from I to IV was based on the patient's level of disability and intensity of pain. Patients in grades I and II were combined together into one group.

Everyone in all three groups received three weeks of multidisciplinary therapy. Sessions lasted eight hours a day, five days a week. Areas of focus included exercises, coping skills, education, and relaxation training. Multidisciplinary treatment also included cognitive behavior therapy, work-related training, and problem solving in stressful situations.

Results were measured at six months. Outcomes were assessed using work status, health status, pain intensity, and functional capacity. Patient satisfaction with therapy was also tested.

The authors found that patients in every stage of chronicity benefitted from therapy. In other words, it's never too late to treat chronic LBP with a multidisciplinary approach.

Even patients in higher stages of chronicity had decreased pain and improved function. Patients who had been unable to return to work before were able to end their sick leave and get back to work.

Future studies must determine what kind of multidisciplinary therapy and how many sessions are needed. This will help reduce costs of therapy and money lost from reduced work productivity.

Mattias Buchner, MD, PhD, et al. The Influence of the Grade of Chronicity on the Outcome of Multidisciplinary Therapy for Chronic Low Back Pain. In Spine. December 15, 2007. Vol. 32. No. 26. Pp. 3060-3066.