You can talk yourself out of lower back pain
By Frederik Joelving (China Daily)
Updated: 2010-03-03 09:15
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People with chronic low-back pain can benefit from cognitive behavioral therapy, a new British report shows.
Low-back pain is one of the most costly and disabling health problems in developed countries, the researchers write in The Lancet, but so far effective treatment has been lacking.
When they added group therapy sessions to standard care - which includes pain medication and advice to stay active - the proportion of patients who got better doubled.
In addition, the benefits lasted longer and cost less than half of that of other interventions such as acupuncture.
"Unlike many of these other treatments," the researchers write, "the benefits of cognitive behavioral intervention were broad-ranging and lasted 12 months, suggesting that these benefits will translate into substantial health gain at a population level."
For the study, researchers from the University of Warwick enrolled 701 people with troublesome daily pain and stiffness in the back and buttocks. Each person was randomly assigned to receive either standard care or standard care and cognitive behavioral therapy.
Experienced nurses or psychologists worked with the 468 people in the therapy group, who received one individual session and six group sessions.
The therapists focused on behaviors and beliefs about physical activity and made patients try to counter negative thoughts.
Over the course of a year, the researchers tested patients' pain and disability. After a year, those participating in talk therapy experienced twice the improvement of patients receiving only standard care.
The percentage of patients reporting recovery was 60 percent in the therapy group and 30 percent in the standard group.
On average, the cost of standard medical advice was about $24, and talk therapy added another $285. This makes the treatment cost-effective compared with other treatments, the researchers say.
Zara Hansen, a physical therapist at the University of Warwick who worked on the study, says that implementing the treatment would not be difficult.
"Health insurance and health maintenance organizations should see it as a cost-effective alternative to current treatments for chronic low-back pain," she says by e-mail.
In a related commentary, pain specialist Dr Laxmaiah Manchikanti notes that only about 60 percent of the patients assigned to therapy completed half of the group sessions. Still, he called the findings "impressive".
"Overall," he writes in The Lancet, "the results suggest that cognitive behavioral therapy is an excellent option for primary-care physicians before they seek specialty consultations for their patients."
But Manchikanti, of the Pain Management Center of Paducah in New York, also points out potential obstacles.
"A practical issue that remains is the availability of group cognitive behavioral therapy on a routine basis for low-back pain in primary care, which might be feasible in countries with national healthcare systems, but not in a country like the United States."
In general, Hansen advises people suffering from back pain to build up new activities gradually and take pain killers if necessary. "Keep as active as possible," she says, "modify your activities if necessary to remain active."