Psychomotor therapy in multidisciplinary rehabilitation for patients with chronic benign pain: the importance of body awareness.

Multidisciplinary cognitive behaviour therapy is reported to be an effective
treatment for chronic pain. However, still many people don*t benefit of this
treatment. Treatment of chronic pain in the Netherlands is advocated on the
basis of biopsychosocial principles (Consensus of Pain Rehabilitation
Netherlands, 2005). According to this view, self-management needs to be
strengthened in order to reach the primary goal of improving quality of life.
Self-management is impaired because the patient experiences a disturbed
interaction between aspects of physical, cognitive and social functioning.
Self-management may be improved by increasing body-awareness, i.e. by paying
more attention to body-signals and by understanding these signals in connection
with thoughts, emotions and behaviour. In this way, the body may function as a
reliable messenger for the state the person is in. In turn, by having more
confidence in one*s own body, self-efficacy will increase, the attribution
style becomes less depressive, and emotions will be faced better. Increasing
body-awareness will channel emotions and be put into a more realistic
perspective. As a result of this process the patient has an increased feeling
of control, better self-management, which will result in a more positive
quality of life.

The objective of the study is to investigate the effect of a MPRP and the
additional effect of psychomotor therapy. This includes the following questions:
1. What are the short-term and long-term effects of a MPRP on quality of life
of patients with chronic pain?
2. Is there an additional short-term and long-term effect of a MPRP which
includes psychomotor therapy on body-awareness and quality of life?
3. Are body-awareness and pain self-efficacy mediating the effect of a MPRP
(with or without psychomotor therapy) on an increased quality of life in
patients with chronic pain?

The study employes a 2 * 5 repeated-measures design with 2 groups (MPRP with
and without psychomotor therapy) and 5 assessment periods (pre-treatment,
post-treatment, 3, 6 and 12 months follow-up). After the inclusion of subjects
in the study, they will undergo cluster randomization into one of both
treatment conditions. Both treatment conditions last 12 weeks in which subjects
will receive treatment 3 days a week. The primary outcome measures are quality
of life, level of functioning and medical consumption. Secondary measures are
physical functioning, emotional functioning (depression, mood), pain intensity
and pain affect. Possible mediating or moderating variables are body-awareness,
self-efficacy, patient expectations and patient satisfaction.

Multidisciplinary Pain Rehabilitation Programme.
This is a group programme with 8 modules, which are presented in 12 weeks
during 3 days a week. The 8 modules are: education, relaxation therapy,
psychosocial therapy, ergonomics, graded activity, partner therapy,
effort/strain therapy. The patient has 4 individual contacts with his/her
contact person, one of the therapists.


Psychomotor therapy is a mind-body therapy which aims at improving
body-awareness by movement- and body-oriented activities. By performing these
activities the patient acquires understanding of bodily signals, emotions and
behaviour, and experiments with other behaviour. Patients receive 10 sessions
of 1,5 hours across 12 weeks.

Patients need to fill out a number of questionnaires at home on several
occasions, which takes about 70 minutes.
During the measure of balance the subjects are allowed to rest between the
different conditions.
The extra measurements in the rehabilitation centre are combined with a
treatment appointment at the rehabilitation centre. In this way the subjects
don't have to travel extra.

The benefit for the subjects is that the treatment can be even more adapted to
their needs.