Psychotherapy may be key to treating chronic back pain

(ORDO NEWS) — A new comprehensive study of more than 13,000 patients suggests that the best treatments for chronic back pain should include both physical and mental aspects, rather than focusing solely on physical remedies.

In a systematic review of 97 previous studies spanning 17 different approaches to treating chronic back pain, the researchers found that adding psychological interventions to treatment – mainly behavioral therapy and pain education – resulted in the most consistent improvement in both physical function and pain intensity.

About 8 percent of adults in the US are thought to experience persistent or chronic back pain, resulting in both medical expenses and lost work days. Thanks to new research, treatment could become more targeted and effective.

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

“However, in fact, very little is known about the various types of psychological therapy and their effectiveness.”

As a result, Ho says both doctors and patients are often unsure about how best to choose a treatment. One of the motivations for the new study was to bring some clarity to what is available and what works best.

For statistical analysis of the study, six main types of psychological interventions were identified, including behavioral interventions, cognitive behavioral therapy, thought therapy, counseling, and pain education programs. The sixth type are studies that combine two or more psychological approaches.

For improving physical function, both cognitive behavioral therapy with physical therapy and pain education with physical therapy were better than physical therapy alone. Behavioral therapy, cognitive behavioral therapy, and pain education have proven to be effective adjuncts for pain reduction.

However, efficacy varied over time, with varying durations across studies. Pain education and behavioral therapy showed the greatest effect at six and 12 months after treatment. Based on available data, these interventions also appear to be safe.

“Studying the comparative efficacy and safety of the wide range of available psychological interventions for chronic low back pain may help improve the clarity of guidelines recommendations and better support clinicians and patients in making treatment decisions,” the researchers write in their paper.

Chronic back pain is defined as pain that lasts more than 12 weeks and is often accompanied by psychological consequences, including anxiety and depression. Such an impact on mental health can lead to further deterioration of a person’s physical health.

In addition to physical function and pain intensity, the research team looked at health-related quality of life, safety, treatment adherence, and fear avoidance, i.e. avoiding movement due to fear of pain. Again, treatment with the addition of psychological measures was shown to produce better results.

Some limitations of the study should be mentioned: the investigators say that the long-term efficacy of these treatments (after 12 months) has yet to be assessed, and some of the trials used in the analysis were of poor quality data on safety.

Overall, however, the new study provides important insights into which psychological interventions work best, and how much more effective complementary therapies can be compared to physical treatments and exercise.

“Clinicians should consider incorporating psychological interventions into physical therapy treatments (mostly structured exercise) to maximize outcomes,” the researchers wrote.

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