Effect of individually tailored biopsychosocial workplace interventions on chronic musculoskeletal pain and stress among laboratory technicians: Randomized controlled trial

Background: chronic musculoskeletal pain is prevalent among laboratory technicians and work-related stress may aggravate the problem. objectives: this study investigated the effect of a multifaceted worksite intervention on pain and stress among laboratory technicians with chronic musculoskeletal pain using individually tailored physical and cognitive elements. study design: this trial uses a single-blind randomized controlled design with allocation concealment in a 2-armed parallel group format among laboratory technicians. the trial “implementation of physical exercise at the workplace (irma09) – laboratory technicians“ was registered at clinicaltrials.gov prior to participant enrolment. setting: the study was conducted at the head division of a large private pharmaceutical company’s research and development department in denmark. the study duration was march 2014 (baseline) to july 2014 (follow-up). methods: participants (n = 112) were allocated to receive either physical,cognitive,and mindfulness group-based training (pcmt group) or a reference group (ref) for 10 weeks at the worksite. pcmt consisted of 4 major elements: 1) resistance training individually tailored to the pain affected area,2) motor control training,3) mindfulness,and 4) cognitive and behavioral therapy/education. participants of the ref group were encouraged to follow ongoing company health initiatives. the predefined primary outcome measure was pain intensity (vas scale 0 – 10) in average of the regions: neck,shoulder,lower and upper back,elbow,and hand at 10 week follow-up. the secondary outcome measure was stress assessed by cohen´s perceived stress questionnaire. in addition,an explorative dose-response analysis was performed on the adherence to pcmt with pain and stress,respectively,as outcome measures. results: a significant (p < 0.0001) treatment by time interaction in pain intensity was observed with a between-group difference at follow-up of -1.0 (95%ci: -1.4 to -0.6). no significant effect on stress was observed (treatment by time p = 0.16). exploratory analyses for each body region separately showed significant pain reductions of the neck,shoulders,upper back and lower back,as well as a tendency for hand pain. within the pcmt group,general linear models adjusted for age,baseline pain,and stress levels showed significant associations for the change in pain with the number of physical-cognitive training sessions per week (-0.60 [95%ci -0.95 to -0.25]) and the number of mindfulness sessions (0.15 [95%ci 0.02 to 0.18]). no such associations were found with the change in stress as outcome. limitations: limitations of behavioral interventions include the inability to blind participants to which intervention they receive. self-reported outcomes are a limitation as they may be influenced by placebo effects and outcome expectations. conclusions: we observed significant reductions in chronic musculoskeletal pain following a 10-week individually adjusted multifaceted intervention with physical training emphasizing dynamic joint mobility and mindfulness coupled with fear-avoidance and de-catastrophizing behavioral therapy compared to a reference group encouraged to follow on-going company health initiatives. a higher dose of physical-cognitive training appears to facilitate pain reduction,whereas a higher dose of mindfulness appears to increase pain. hence,combining physical training with mindfulness may not be an optimal strategy for pain reduction. trial registration: nct02047669. © 2015,american society of interventional pain physicians. all rights reserved.