Cognitive Behavioral Therapy Beneficial, Cost-effective, U.K. Study Finds
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Reviewed By Louise Chang, MD
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Feb. 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."
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.
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 Sheet."
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