Body Awareness as an Important Target in Multidisciplinary Chronic Pain Treatment: Mediation and Subgroup Analyses

BACKGROUND: The results of a recently performed RCT (1) showed that the effect of a multidisciplinary treatment of chronic pain patients on body awareness, catastrophizing and depression was improved by adding psychomotor therapy (PMT), an intervention targeting body awareness (BA). No significant effects were found on quality of life and disability. The present follow-up study aims to explore the relationship between improvements in BA and multidisciplinary chronic pain rehabilitation treatment outcome across treatment conditions and the possible mediating effect of BA between treatment conditions. Furthermore, the hypothesis that patients with low BA benefit more from PMT was investigated.

METHODS: 94 patients with chronic pain participated in a RCT comparing multidisciplinary treatment as usual (TAU) with TAU plus PMT. Outcome variables were health-related quality of life, disability and depression. Self-efficacy and catastrophizing were the process variables of treatment and the potential mediating factors in the relationship between BA and the outcome variables. The data were analysed by linear mixed model analysis.

RESULTS: Improvements in BA were related to improvements in all outcome variables across treatment conditions. The relationships were partly mediated by self-efficacy and/or catastrophizing. In the regression model with depression as the outcome variable the regression coefficient of treatment (i.e. PMT vs. TAU) decreased with 34% and became non-significant when BA was added as a potential mediator. Patients with low body awareness seemed to benefit more from PMT than patients with high body awareness, especially on depression, body awareness and catastrophizing.

CONCLUSIONS: BA might be an important target of treatment to improve the multidisciplinary treatment outcome in chronic pain patients. Furthermore, PMT is an intervention that appears to provide its benefits through improving BA and may be especially beneficial for patients with low BA.