Culturally sensitive group therapy for Turkish patients suffering from chronic pain: A randomised controlled intervention trial

Abstract

SUMMARY OF BACKGROUND DATA: The incidence of chronic pain is higher among immigrants in Europe than among the native European population. Therapeutic interventions in this population are far less effective than in patients for whom these programmes were originally developed. OBJECTIVES: In a randomised trial, we investigated whether a cognitive behavioural treatment (CBT) programme supplemented with culturally sensitive aspects (CsCBT) improves pain intensity, pain disability and quality of life among immigrant patients, compared with a treatment of culturally sensitive exercise therapy (CsET) alone. Furthermore, we investigated whether healthcare costs would decrease. METHODS: First-generation Turkish immigrants residing in Switzerland (20-65 years of age) who suffered from chronic pain were enrolled in the trial. Patients were randomised to attend either CsCBT or CsET. The CsCBT intervention was based upon a manualised cognitive-behavioural group treatment programme for chronic pain patients and adapted to the needs of a Turkish immigrant population. The CsET intervention was based on principles of exercise therapy for treatment of nonspecific low back pain. RESULTS: A total of 116 outpatients were recruited between October 2004 and November 2006. The intervention was completed by 89 patients (77%). A total of 78 subjects (67%) completed follow-up, 12 months after the completion of the intervention programme. The intervention showed no effects in reducing pain, pain disability or quality of life. The analysis of healthcare utilisation yielded no intervention effect. CONCLUSIONS: Cognitive behavioural intervention is feasible with immigrants with chronic disabling pain, but the evidence-based CBT programme, as well as exercise therapy supplemented with culturally sensitive aspects, showed no improvement.