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Cognitive Behavioral Therapy: Beneficial For Back Pain
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barbara
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Joined: Fri Feb 02, 2007 9:11 pm
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Location: Buffalo, N.Y.
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 Cognitive Behavioral Therapy: Beneficial For Back Pain Cognitive Behavioral Therapy: Beneficial And Low Cost Treatment For Back Pain
26 Feb 2010
An article published in this week's issue of The Lancet reports that group cognitive behavioral therapy (CBT) can reduce low-back pain at a low cost to the health-care provider. Furthermore, one year after the start of treatment, the improvement was sustained.
Ranked as one of the top three most disabling conditions in the developed World, persistent low-back pain is increasingly common. It can be very debilitating. Because it is so widespread, back pain is also costly to treat.
A randomized controlled trial was undertaken by Professor Sarah E Lamb, at the Warwick Clinical Trials Unit, Warwick Medical School, University of Warwick, Coventry, UK, and colleagues. It included a total of 701 patients with troublesome subacute or chronic low-back pain from general practices across England. The researchers aimed to determine whether group cognitive behavioral therapy would offer any added benefit to best practice advice in primary care. This advice included recommendations on staying active and correct use of pain medication.
The patients were then randomly assigned to two groups:
• 468 participants were given up to six sessions of group CBT
• 233 controls were given no additional treatment
In each group, 85 percent of participants completed the study. Primary outcomes were the change at one year from baseline in Roland Morris disability questionnaire and modified Von Korff scores. Both are tools to measure pain and disability.
After one year, results indicate that CBT had significantly improved both disability scores. The change from baseline in the Roland Morris questionnaire was 2.4 points in the CBT group compared with 1.1 points in controls. The Von Korff score changed by 13.8 percent in the CBT group and 5.4 percent in controls. Importantly, the treatment was cost-effective. The cost per quality-adjusted life-year was about half that of competing treatments such as acupuncture.
The authors comment: "Effective treatments that result in sustained improvements in low-back pain are elusive. This trial shows that a bespoke cognitive behavioural intervention package, BeST, is effective in managing subacute and chronic low-back pain in primary care. The short-term effects (4 months) are similar to those seen in high-quality studies and systematic reviews of manipulation, exercise, acupuncture, and postural approaches in primary care."
Because the participants were representative of the ethnic mix of the UK and came from a mix of rural and urban areas, the authors consider that the treatment could have a broad applicability. They also observe that 95 percent of the CBT session time was intended towards achieving psychological goals rather than on supervised exercise.
They write in conclusion: "A bespoke cognitive behavioural intervention package for low-back pain has an important and sustained effect at 1 year on disability from low-back pain at a low cost to the health-care provider."
In an associated note, Dr Laxmaiah Manchikanti, Pain Management Center of Paducah, Paducah, KY, USA, comments that Lamb and colleagues' study "showed rather impressive results."
Manchikanti warns about the routine availability of group CBT for low-back pain in primary care. It "might be feasible in countries with national health-care systems, but not in a country like the USA."
He says in closing that "the results suggest that cognitive behavioural therapy is an excellent option for primary care physicians before they seek specialty consultations for their patients."
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| Fri Feb 26, 2010 2:45 pm |
 
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leitwolf
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Joined: Fri Jan 19, 2007 2:53 am
Posts: 4387
Location: dallas, nc
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Talk Therapy May Treat Low Back Pain Quote:
Talk Therapy May Treat Low Back Pain
Cognitive Behavioral Therapy Beneficial, Cost-effective, U.K. Study Finds
By Salynn Boyles
WebMD Health NewsReviewed by Louise Chang, MDFeb. 25, 2010 -- A treatment designed to challenge how people with low back pain 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 year.
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 problems.
"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."
Separate Fact From Fiction in WebMD's Back Pain Myths Slideshow
CBT for Low Back Pain
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 treatments.
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 researchers report.
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 therapy.
‘No One-Size-Fits-All Treatment’
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 Lancet.
"There will never be a one-size-fits-all treatment for low-back pain," Hansen says. "Group cognitive behavioral therapy gives patients another choice."
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 is.
Manchikanti directs the Pain Management Center of Paducah in Paducah, Ky.
"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.
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| Wed Mar 10, 2010 2:59 am |
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