Psychotherapy may be key to managing chronic back pain -Report

A comprehensive new study involving more than 13,000 patients suggests that the best treatments for chronic back pain should cover both physical and mental aspects – rather than concentrating solely on physical remedies.

The report which was recently published in the peer-reviewed journal The BMJ conflates a systematic review of 97 previous trials covering 17 different approaches to handling chronic back pain.

Researchers found that adding psychological interventions to treatments – mainly behavioural therapy and pain education – led to the most sustainable physical benefits for both function and pain intensity.

“Clinical guidelines consistently recommend a combination of exercise and psychosocial therapies for managing chronic low back pain,” says physiotherapist Emma Ho from the University of Sydney in Australia.

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“However very little is actually known about the different types of psychological therapies available and their effectiveness,” Ho said.

Researchers identified six main types of psychological interventions for statistical analysis to include behavioural interventions, cognitive-behavioural therapies, mindfulness, counseling, and pain educational programs. The sixth type was trials where two or more psychological approaches were combined.

For improving physical function, both cognitive behavioural therapy with physiotherapy and pain education with physiotherapy were better than physiotherapy alone. For help with pain intensity, behavioural therapy, cognitive-behavioural therapy, and pain education were all shown to be effective additions.

The effectiveness changed over time though, with different trials operating over different durations. Pain education and behavioural therapy were shown to have the most impact over six and 12 months after treatment. Based on the available data, these interventions appear to be safe too.

“Examining the comparative effectiveness and safety of the wide range of available psychological interventions for chronic lower back pain might help to improve the clarity of guideline recommendations and better support clinicians and patients in treatment decision making,” the researchers write in their paper.

Chronic back pain is defined as pain that lasts more than 12 weeks, and it often comes with psychological effects attached, including anxiety and depression. Those mental health impacts can then cause the physical health of an individual to deteriorate further.

The outcomes that the team looked at besides physical function and pain intensity were health-related quality of life, safety, compliance with treatment, and fear-avoidance – that is, avoiding movement through the fear of pain. Again, treatments with added psychological measures were shown to get better results.

There are some limitations to the study to talk about: the researchers say the long-term effectiveness of these treatments (beyond 12 months) still needs to be assessed, and some of the trials used in the analysis had poor quality safety reporting data.

However, taken as a whole, the new research provides important insights into which psychological interventions work best, and how much more effective complementary treatments can be overall compared to relying solely on physical treatments and exercises.

“Clinicians should consider incorporating psychological interventions with physiotherapy care (mainly structured exercise) to maximize improvements in health outcomes,” write the researchers.

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