Can You Talk Your Way Out of Chronic Back Pain?

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Cognitive behavioral therapy may help patients with chronic or acute low-back pain, British researchers say.

Patients involved in the intervention -- which focused on beliefs and behaviors regarding exercise -- experienced measurably more relief from pain and disability than those who did not have the therapy after one year, Dr. Sarah Lamb of the University of Warwick and colleagues reported online in the journal Lancet.

"Effective treatments that result in sustained improvements in low-back pain are elusive," they wrote. "This trial shows that a bespoke cognitive behavioral intervention package ... is effective in managing sub-acute and chronic low-back pain in primary care."

There have been some proof-of-concept studies that support cognitive behavioral interventions for back pain patients, but more conclusive research was needed.

So the researchers conducted the Back Skills Training (BeST) trial among 701 patients with sub-acute or chronic low back pain that existed for at least six weeks. The patients, with a mean age of 54, were recruited from 56 general practices.

Patients received either advice alone or advice plus the cognitive behavioral therapy. Some 468 patients wound up in the group that received the therapy.

The researchers found that compared with advice alone, the cognitive behavioral intervention was associated with significant benefits in nearly all outcomes at 3, 6, and 12 months.

At one year, disability scores on the Roland Morris scale improved significantly more in the intervention group than in the control group. Pain scores as estimated on the Von Korff scale similarly improved more significantly in the intervention group. For self-rated benefit from treatment, significantly more intervention participants reported recovery at one year.

On average, cognitive behavioral therapy was ostensibly more expensive than no therapy, at £421 (or $644 at current exchange rates) versus £224 ($343) per patient.

However, the researchers said that this intervention was likely cost-effective, particularly considering the costs of other treatments delivering the same benefit. Soem other interventions with which the cognitive behavrioal therapy was compared included:

Acupuncture (£4,242 or $6,490)

Exercise (£3,800 or $5,814)

Manipulation (£8,700 or $13,311)

Postural approaches (£3,090 or $4,728).

"The results of this cost-utility analysis reinforce the conclusion that this is a clinically worthwhile intervention," the researchers wrote.

In an accompanying editorial, Dr. Laxmaiah Manchikanti of the Pain Management Center of Paducah in Kentucky, wrote that the results were impressive. But he cautioned that only 63 percent of the patients in the intervention group actually complied with treatment, and cognitive therapy is significantly more expensive than advice alone.

"Overall, the results suggest that cognitive behavioral therapy is an excellent option for primary care physicians before they seek specialty consultations for their patients," she wrote, but cautioned that the treatment "is not a panacea."

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