Adding psychological interventions to physiotherapy (aka physical therapy) may help manage chronic low back pain better than physiotherapy alone, according to a systematic review in BMJ of 97 randomized controlled trials involving more than 13,000 people.
Participants had low back pain of at least 12 weeks’ duration and with no known anatomical cause. Combining physiotherapy (mostly structured exercise) with behavioral therapy was deemed best for reducing pain intensity, while co-delivery of physiotherapy with cognitive behavioral therapy or with pain education improved physical functioning and fear avoidance behaviors most. (Behavioral therapy and cognitive behavioral therapy differ in that the former focuses on altering behaviors to improve outcomes, while the latter challenges thoughts to lead to healthier behaviors and mood.)
Although clinical effectiveness lessened over time, the authors propose that such psychological interventions be integrated with physiotherapy at the onset of treatment for low back pain.
What’s the connection between back pain and the mind? Psychological factors play a large role in how back pain is experienced and how it impacts daily functioning and overall well-being. Chronic pain is often accompanied by depression, anxiety, and catastrophic thinking, for example, which can lead to avoidance of usual activities and diminished quality of life. Psychological interventions can help change negative beliefs, attitudes, and behaviors, and thus have “strong potential to help patients with building resilience and psychological flexibility to better cope (that is, self-manage) with the physical and psychosocial challenges of living with chronic pain,” the authors wrote.
