Psychological Treatments Improve Outcomes for Back Pain Sufferers

Psychological interventions for chronic low back pain are effective, a new review of studies has found. Not only do these approaches improve psychological outcomes such as depression and health-related quality of life, they also reduce patients' experience of pain.

"Because this analysis was both more inclusive and more conservative than previous reviews, we have the best evidence to date that these interventions are helpful," said psychologist and review lead author Robert Kerns, Ph.D., of the VA Connecticut Healthcare System.

The review, part of a new article series, appears in the January issue of the journal Health Psychology. Each evidence-based review centers on a specific psychological assessment or treatment conducted in the context of a physical disease process or risk reduction effort.

To evaluate the effects of psychological interventions on pain-related outcomes, Kerns and his team gathered data from 22 randomized trials published between 1982 and 2003. Trials were limited to adults with nonmalignant low back pain that had persisted for at least three months. However, most patients had been living with pain for much longer. The average duration was seven and a half years.

The studies were not limited to any one psychological approach. Included in the review were behavioral and cognitive-behavioral techniques; self-regulatory techniques such as hypnosis, biofeedback, and relaxation; and supportive counseling.

The review reports on 12 pain-related outcomes, including pain intensity, pain interference, depression, health care use, disability and health-related quality of life.

In the broadest analysis, psychological interventions — alone or as part of a multidisciplinary approach — proved to be superior to waiting lists or standard treatments on the entire range of pain-related outcomes.

When the researchers analyzed specific outcomes, they found that the largest and most consistent effect was a reduction in pain intensity.

This was somewhat surprising, Kerns said, because when psychologists first began developing interventions for chronic pain several decades ago, the goal was not to reduce pain but to help patients live with their pain more successfully.

“However, a growing body of knowledge suggests that these interventions are actually having a primary effect on people’s experience of pain,” he said.

The review found that psychological interventions also yielded improvements in health-related quality of life, work-related disability, interference of pain with daily living and depression.

Not all treatments were equally effective. Cognitive-behavioral and self-regulatory treatments seemed to yield the greatest effects, particularly when compared to waiting list control groups. Multidisciplinary approaches that included a psychological component also stood out on some measures, reducing pain interference and work-related disability when compared to other active treatments.