Fear of Back Pain Disables More Than the Pain Itself
Low back pain (LBP) is a common problem and one for which we don't have a "one-size-fits-all" treatment. In this study researchers at a center for work rehabilitation in Switzerland compared two treatment methods for LBP.

Three weeks of function-centered rehab were compared to three weeks of a pain-centered program. Number of days at work, pain levels, strength, and lifting capacity were used as measures of results. Follow-up was for three months.

Patients in both groups had missed at least six weeks of work due to chronic LBP. The function-centered treatment (FCT) group spent four hours each day, six days a week for three weeks doing work activities and strength training. Their program also had endurance and aerobic training. The main goal for this group was to increase their work capacity.

The pain-centered treatment (PCT) group took back care classes and got joint mobilization and stretching. They also did strength training. The program lasted two and a half hours each day, six days a week for three weeks. The goal for this group was to decrease pain. Increasing strength and function were secondary goals.

The authors report much better results for the FCT group. The PCT group did not have the pain relief expected. Pain did decrease in the FCT group even though they were told to move when it hurt. The FCT group were much more confident during normal, daily activities.

The authors conclude fear of pain may be more disabling than the pain itself. The FCT program works best to decrease work-related disability.
Jan P. Kool, MSc, PT, et al. Increasing Days at Work Using Function-Centered Rehabilitation in Nonacute Nonspecific Low Back Pain: A Randomized Controlled Trial. In Archives of Physical Medicine and Rehabilitation. May 2005. Vol. 86. No. 5. Pp. 857-864.