Talking therapy combined with physiotherapy is preferred option for people with chronic lower back pain
People with chronic lower back pain and related stress could benefit from a form of talking therapy, says research in BMC Musculoskeletal Disorders. And a combination of talking therapy and physiotherapy to address both the psychological and physical aspects of back pain is the preferred option.
Lower back pain is one of the most common and expensive health problems in the UK and a wide body of evidence is starting to emerge suggesting that psychological factors can play a big part of managing it. Contextual cognitive behavioural therapy (CCBT) seems to be particularly promising, as it focuses on accepting pain and learning to live life to the full despite it.
So experts carried out a study to test contextual cognitive behavioural therapy compared to physiotherapy in 89 people with lower back pain who’d had pain for at least three months, high levels of psychological distress, avoided everyday activities and were known as “fear avoidant”.
The volunteers were split into groups. Some received contextual cognitive behavioural therapy (eight sessions delivered by trained psychologists on a one-to-one basis). Others had physiotherapy, which involved back to fitness group exercise exercises.
“Our study found that contextual cognitive behavioural therapy is acceptable to patients, but interestingly many patients who took part, as well as several of the clinicians involved – both psychologists and physiotherapists – thought the best treatment was a combination of both physiotherapy and CCBT,” says lead researcher Prof Tamar Pincus. “Patients and clinicians felt the best solution would be to deal with both physical difficulties and psychological problems.”
Personal touch
People also reported that they wanted their talking therapy to be on a one-to-one basis, contrasting with current trends of group sessions.
“We know that for some people with chronic low back pain psychological stress is a major factor, and therefore there is a significant challenge to find effective treatments,” explains Dr Stephen Simpson from Arthritis Research UK.
“This pilot study has shown that combining physical and psychological approaches could be the way forward to treat this common, often disabling condition more effectively.”
Next on the agenda is a larger trial to explore if the combination of physiotherapy and psychology will improve outcomes and reduce treatment costs.
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Image credit: Sean Jackson
