WebMD Health News
Louise Chang, MD
Feb. 25, 2010 -- A treatment designed to challenge how people with low back
think about their condition and change their behaviors was shown to have
long-term benefits in a newly published study.
Cognitive behavioral therapy (CBT) proved more effective than a single
session with a health care provider in reducing pain over the course of a
The study is among the largest ever to examine CBT for chronic back
pain, which is among the most common, costly, and difficult-to-treat health
"This wasn’t psychotherapy and we absolutely are not saying that
back pain is a psychological problem,” study co-author Zara Hansen tells WebMD.
"Back pain is very much a physical problem, but the way a patient thinks about
it can affect how it is managed."
Most adults experience low back pain at some point in their lives. In many,
the pain goes away after a few days or weeks, but in others it can last for
months or come and go for many years.
Americans spend at least $50 billion each year on low back pain, and it is
the most frequent cause of job-related disability, according to the National
Institutes of Health.
Pain-relieving drugs, exercise, spinal manipulation, surgery, and even
alternative treatments such as acupuncture and biofeedback have all shown some success
in the treatment of low back pain, but many patients do not respond to these
To test the benefits of CBT as a therapy for chronic low back pain, Hansen
and colleagues from the University of Warwick in England recruited 701 patients
from general medicine practices across the country.
All the patients had an initial consultation that lasted about 15 minutes
and stressed the benefits of remaining active, avoiding bed
rest, and taking pain medication when appropriate. They were also given a
book to read, which described various treatments for back pain.
About a third got no other intervention but were allowed to seek additional
treatment on their own. The rest had a thorough one-on-one medical assessment
and participated in up to six sessions of group cognitive behavioral therapy
over the course of about three months.
The CBT sessions focused on participants’ thoughts and behaviors about back
pain and physical activity. By helping people identify negative beliefs, they
can change behaviors.
Information on back pain was collected three months after the patients
entered the study, and then again at six and 12 months.
After three months, the impact of the CBT intervention was comparable to
that reported for established low back
pain treatments like exercise, acupuncture, and manipulation, the
After 12 months, almost twice as many patients in the CBT group reported
having no back pain (59% vs. 31%). Sixty-five percent reported being satisfied
with their treatment, compared to 43% of patients who did not have the group
The researchers conclude that group cognitive behavioral therapy should be
considered a useful and cost-effective treatment for chronic low back pain.
The study appears online in the Feb. 26 issue of the journal The
"There will never be a one-size-fits-all treatment for low-back pain,"
Hansen says. "Group cognitive behavioral therapy gives patients another
In an editorial accompanying the study, pain management specialist Laxmaiah
Manchikanti, MD, expressed skepticism about the ability to offer CBT for pain
management in the United States, no matter how effective the intervention
Manchikanti directs the Pain Management Center of Paducah in Paducah,
"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 health-care systems, but not
in a country like the USA," he writes.
Hansen, who developed the CBT training program used in the U.K. study,
concedes that patients with chronic back pain in the U.S. who want to try group
cognitive therapy may have a hard time finding it.
SOURCES:Lamb, S.E., The Lancet, Feb. 26, 2010; online edition.Zara Hansen, clinical research fellow, Warwick Medical School, University of
Warwick, Coventry, England.Manchikanti, L., The Lancet, Feb. 26, 2010; online edition. National Institute of Neurological Disorders and Stroke: "Low Back Pain Fact
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