Treatment expectations but not preference affect outcome in a trial of CBT and exercise for pain

The following are members of the MUSICIAN study team: Gary Macfarlane (Principal Investigator), John McBeth (Investigator), Deborah Symmons (Investigator), Karina Lovell (investigator), Philip Keeley (Investigator), Phil Hannaford (Investigator), Chrysa Gkazinou (Trial manager), Marcus Beasley (Research Assistant), Elizabeth Jones (PhD student), Gordon Prescott (Statistician), and Steve Woby (Investigator). We are grateful to the practices and patients in Aberdeen city and Cheshire, which participated in the study: Carden medical centre, Elmbank medical practice, Great Western Road medical practice, Garthdee medical group, Readesmoor medical group practice, Lawton House surgery, Bollington medical practice, Park Lane surgery. The Scottish Primary Care Research Network facilitated access to patient information at the practices in Aberdeen city. Charlie Stockton was the study manager and Ashraf El-Metwally an Investigator during the setting up and for part of the conduct of the study. John Norrie was originally an investigator of the MUSICIAN study while Director of the Centre for Health Care Randomised Trials (CHART) at the University of Aberdeen. We are grateful for the input of members of the Health Services Research Unit (HSRU) at The University of Aberdeen in the conduct of the study: Alison MacDonald and Gladys McPherson. We are grateful to the project assistants who worked on the survey: Dev Acharya, Jennifer Bannister, Flora Joyce, Michelle Rein., Karen Kane, and Rowan Jasper. Alison Littlewood was responsible for study management at the Cheshire site. Finally, we thank the independent members of the trial steering committee (Professor Matthew Hotopf, Professor Tracey Howe, Professor Martin Underwood) and data monitoring committee (Dr. Marwan Bukhari, Professor Hazel Inskip, Dr. Chris Edwards). Funding details The study was funded by Arthritis Research UK, grant number 17292.Peer reviewedPublisher PD

The prevalence and management of low back pain across adulthood: Results from a population-based cross-sectional study (the MUSICIAN study)

The aim of the current study was to determine: the prevalence of low back pain (LBP) and associated disability; the frequency of consultation to general practice; whether there were differences in management by age. We conducted a cross-sectional population study in Aberdeen city and Cheshire County, UK. Participants were 15,272 persons aged 25 years and older. The 1-month period prevalence of LBP was 28.5%. It peaked at age 41-50 years, but at ages over 80 years was reported by 1 in 4 persons. Older persons were more likely to consult, and the prevalence of severe LBP continued to increase with age. Management by general practitioners differed by age of the patient. Older persons (> 70 vs 70 vs <40 years) were more likely to only have been prescribed painkillers (odds ratio [OR] 1.74, 95% confidence interval [CI] 1.28-2.35) or only pain killers with other medications (OR 1.45, 95% CI 1.07-1.98). They were less likely to be prescribed physiotherapy or exercise (OR 0.63, 95% CI 0.46-0.85) or to be referred to a specialist (OR 0.77, 95% CI 0.57-1.04). Older persons were more likely to have previously received exercise therapy for pain, were less likely to be enthusiastic about receiving it now (P < 0.0001), and were less likely to think it would result in improved symptoms (P < 0.0001). It is important that older persons, who have the highest prevalence of LBP with disability and are most likely to consult, are receiving optimal pharmacological and nonpharmacological management

Long-term effects of cognitive behaviour therapy and exercise for chronic widespread pain

Background Cognitive behaviour therapy (CBT) and exercise have been shown to improve short-term outcomes for chronic widespread pain (CWP) patients. There is little data on whether improvement maintains long-term. Methods or theme The MUSICIAN Trial was a 2 x 2 factorial randomised controlled trial. A survey of general practitioner (GP)-registers identified CWP patients consulting their GP in the last year. Random assignation was to four study arms: the Cognitive Behavior Therapist (tCBT), exercise, combined treatment, or treatment as usual (TAU). tCBT participants had eight weekly telephone sessions and three and six month follow-up calls. Exercise group participants followed an individual fitness-instructor designed program over six months with monthly review. Combined treatment participants received both interventions. TAU participants received usual care. Follow-up by postal questionnaire or telephone was 24 months post-treatment. Positive outcome was patient-reported change in health of ‘much’ or ‘very much’ better. Analysis was by logistic regression and odds ratios (ORs) with 95% confidence intervals (CIs) are reported. Results Totally 442 persons participated (median age 57 years, 69% female) – 361 had 24-month follow-up. Of 94 respondents, 12 (12.8%) in TAU reported positive outcomes, 29 of 82 in tCBT (35.4%), 27 of 92 in exercise (29.3%) and 29 of 93 in combined treatment (31.2%). ORs compared to TAU were: tCBT, OR 4.0 (95% CI, 1.8–8.7); exercise, 2.9 (1.4–6.3); combined, 3.5 (1.6–7.5). Improvement odds did not differ across active treatments – there was no advantage in receiving both interventions. Conclusions tCBT and/or exercise for CWP are associated with long-term patient-reported health improvements. These are amongst the largest, longest-term benefits reported for CWP and offer potential management strategies