Pain, 11 (1981) 221--231 Elsevier/North-Holland Biomedical Pre~ 221 BEHAVIORAL TREATMENT OF CHRONIC LOW BACK PAIN: CLINICAL OUTCOME AND INDIVIDUAL DIFFERENCES IN PAIN RELIEF FRANCIS J. KEEFE *, ANDREW R. BLOCK, REDFORD B. WILLIAMS, Jr. and RICHARD S. SURWIT Duke University Medical Center, Durham, N.C. (U.S.A.) (Received 28 November 1981, accepted 5 May 1981) SUMMARY The response of 111 chronic low back pain patients to a comprehensive behavioral treatment program emphasizing relaxation procedures is exam- ined. Over the course of treatment, significant reductions were obtained on measures of subjective tension, EMG activity, and pain. Many patients also decreased their intake of analgesic/narcotic agents and reported an increase in activity level. In order to examine individual differences in pain relief, the 28 patients who had the greatest decreases in pain were compared to those who had the least decreases in pain. Patients who had the best outcome in terms of pain relief were significantly more likely to show improvements in other outcome measures. In addition, these patients rated ti~eir pain initially as more severe, had continuous pain for fewer years, and were less likely to be on disability or to have had multiple surgical procedures. These results are discussed in the light of recent data from other behavioral treatment studies with chronic low back pain patients and implications for behavioral assess- ment and treatment are discussed. INTRODUCTION There is growing interest in the use of behavior therapy and behavior mod- ification techniques in the context of comprehensive treatment programs for chronic low back pain patients. The pioneering work of Fordyce and his colleagues [ 4,5 ] demonstrated the utility of operant conditioning techniques * Requests for reprints should be sent to: Francis J. Keefe, Ph.D., Box 3926, Duke Uni- versity Medical Center, Durham, N.C., U.S.A. Paper presented at the Second Annual Meeting of the American Pain Society, New York, N.Y., 1980. 0304-3959/81/0000--0000/$02.50 © 1981 Elsevier/North-Holland Biomedical Press