The Effectiveness of Risk-stratified Care in Addressing Pain-related Attitudes and Beliefs for Patients with Low Back Pain - I-MESH 2024

Greenlee t, george s, pickens b, rhon d

Abstract accepted for oral presentation at the Symposium of the International Musculoskeletal, Mental, and Social Health (I-MESH) Consortium

A recent trial in the Military Health System (MHS) found risk-stratified care not superior to usual care for low back pain (LBP) for a primary outcome of self-reported disability. Because risk-stratified care follows a biopsychosocial framework and aims to target maladaptive beliefs, the question remains whether the intervention adequately addresses pain attitudes and maladaptive beliefs. We aimed to compare improvements in (1) pain attitudes related to harm and (2) pain knowledge and beliefs in patients with LBP based on assigned intervention (riskstratified versus usual care).

Risk-stratified care significantly improved maladaptive attitudes and beliefs about pain at six weeks compared to usual care. An attenuated treatment effect, regardless of treatment, was seen in high or medium versus low-risk patients. Although these changes did not translate to better clinical outcomes in the clinical trial, they reflect short-term success of risk-stratified care in decreasing maladaptive attitudes and beliefs about pain.