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Study sheds light on psychological therapies for chronic low back pain

Back Pain

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Led by Ms Emma Ho and Professor Paulo Ferreira of the University of Sydney, Australia, it suggests that a combination of physiotherapy combined with psychological interventions is more effective at improving physical function and pain intensity — findings that may help clarify Improve guideline recommendations to support patients and clinicians in treatment decision making.

Adults with chronic low back pain (lasting more than 12 weeks) not only experience physical disability, but may also experience psychological distress in the form of anxiety, depression, and fear avoidance (avoid movement for fear of pain).

Clinical guidelines therefore consistently recommend a combination of exercise and psychosocial therapies for the management of chronic low back pain. But not much is known about the different types of psychological therapies available and their effectiveness, which often leaves doctors and patients unclear about the best choice of treatment.

To address this uncertainty, researchers based in Australia and Canada investigated the efficacy and safety of general psychological interventions on physical function and pain intensity in adults with chronic low back pain.

They searched research databases for randomized controlled trials comparing psychological interventions to any comparative intervention in adults with chronic, non-specific low back pain.

Psychological interventions are grouped into six nodes: behavioral interventions, cognitive behavioral therapies (often called ‘speech therapies’), awareness, counseling, pain education programs, and two or more combined psychological approaches (e.g., pain education delivered with behavioral therapy).

Comparative interventions were classified as physiotherapy care, general practitioner care, counseling, no intervention and ordinary care.

A total of 97 randomized controlled trials involving 13,136 participants and 17 treatment approaches were included, most of which were published between 2011 and 2021 and conducted in Europe.

In general, the researchers found that compared to physiotherapy care alone, physiotherapy delivered with psychological interventions was more effective at improving physical function and pain intensity.

Compared with physiotherapy care alone, the results show that both cognitive behavioral therapy and pain education provided with physiotherapy care resulted in clinically significant improvements in physical function up to 2 months after treatment.

However, the clinical benefits of pain education over physical function were more sustainable and lasted up to 6 months after treatment.

For pain intensity, behavioral therapy, cognitive behavioral therapy, and pain education provided with physiotherapy care resulted in clinically significant effects up to 2 months after treatment.

However, only behavioral therapy delivered with physiotherapy care retained these clinically significant effects on pain intensity up to 12 months after treatment.

And while cognitive behavioral therapy delivered with physiotherapy was the most effective intervention to reduce fear avoidance up to 2 months after treatment, the most sustainable effects for fear avoidance were achieved with pain education programs delivered with physiotherapy care.

Finally, of the 20 studies that provided sufficient information on adverse effects, 12 (60%) clearly reported that no adverse events occurred in any intervention group. However, the researchers are concerned about the poor quality of security data reporting.

It was a well-designed review that captured a wide range of general psychological interventions and examined outcomes that are meaningful to patients and clinicians. However, the researchers acknowledge certain limitations, including differences in trial design and quality that may have influenced their results.

Nevertheless, they write: “For people with chronic, non-specific low back pain, psychological interventions are most effective when delivered in conjunction with physiotherapy care (mainly structured exercise). Pain education programs and behavioral therapy lead to the most sustainable effects of treatment.; however, uncertainty about their long-term effectiveness. “

They conclude: “Findings from our study can be used to provide clearer guideline recommendations on the use of specific psychological interventions for the management of chronic, non-specific low back pain and supportive decision-making for patients and clinicians.”

CBT intervention with yoga and education components improved pain management for patients on long-term opioids

More information:
Psychological interventions for chronic, non-specific low back pain: systematic review with network meta-analysis, The BMJ (2022). DOI: 10.1136 / bmj-2021-067718

Provided by British Medical Journal

Quotation: Study sheds light on psychological therapies for chronic low back pain (2022, March 30) Retrieved March 30, 2022 from

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