Talk therapy reduces back pain

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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 were lasting 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 behavioural intervention were broad ranging and maintained at 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 16 GBP, ($24 US), and talk therapy added another 187 GBP ($285 US). 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, told Reuters Health that implementing the treatment would not be difficult.

“Health insurance and health maintenance organisations should see it as a cost effective alternative to current treatments for chronic low back pain,” she said by e-mail.

In a related commentary, pain specialist Dr. Laxmaiah Manchikanti noted 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 wrote in The Lancet, “the results suggest that cognitive behavioural 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 pointed out potential obstacles:

“A practical issue that remains is the availability of group cognitive behavioural 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.”

In general, Hansen advised people suffering from back pain to build up new activities gradually and take pain killers if necessary. “Keep as active as possible,” she said, “modify your activities if necessary to remain active.”

SOURCE: Lancet, February 26, 2010.

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