Dec
If you’ve ever struggled with low back pain, you know that it can be surprisingly debilitating, even if the discomfort is short-term. You may find it difficult to grocery shop, do housework, play sports, or even tie your shoelaces. When back pain is chronic, lasting 12 weeks or longer, it can impair quality of life and physical function, and contribute to or worsen stress, anxiety, and depression.
While people dealing with chronic back pain are often directed to physical therapy, research shows that psychological approaches that teach strategies to manage your experience of pain can help. So, would combining these approaches do more to ease the pain? A recent systematic review of multiple studies suggests that it might.
How big is this problem, and what did this study find?
Low back pain is a widespread issue globally, affecting over 560 million people and standing as a leading cause of disability. In the United States, a significant portion of the population experiences low back pain, with four in 10 people reporting such pain within the past three months. A recent review published in TheBMJ, drawing on 97 studies, sheds light on effective approaches for chronic, nonspecific low back pain in adults. Here are key findings from the review:
1. Study Overview:
- The review encompassed 97 studies involving adults with chronic, nonspecific low back pain, with or without leg pain.
2. Therapeutic Focus:
The researchers assessed the effectiveness of various therapies aimed at improving three key aspects:
- Physical function (e.g., standing, climbing stairs, managing personal care)
- Fear avoidance (addressing the fear of pain that can lead to movement avoidance)
- Pain intensity (measured by validated rating scales).
3. Combined Approach:
- Physical therapy combined with psychological approaches, such as pain education and cognitive behavioral therapy, demonstrated superior effectiveness compared to physical therapy alone.
4. Specific Findings:
- For improving physical function and fear avoidance, pain education programs alongside physical therapy yielded sustained effects.
- For alleviating pain intensity, behavioral therapy combined with physical therapy resulted in longer-lasting benefits.
5. Interdisciplinary Approach:
- The study underscores the advantages of an interdisciplinary approach to chronic low back pain. Integrating behavioral therapy and physical therapy proved beneficial in enhancing function, breaking the cycle of avoidance behavior, and reducing pain intensity.
6. Real-World Impact:
- The combined approach has the potential to lead to more productive workdays, improved sleep, increased participation in social activities, and overall enhanced well-being for individuals dealing with chronic low back pain.
These findings highlight the significance of integrating psychological approaches with physical therapy in addressing the multifaceted challenges of chronic low back pain and improving overall outcomes for affected individuals.
What else should you know about this study?
The term “chronic, nonspecific low back pain” refers to pain experienced between the bottom of the rib cage and the buttocks crease without an identified structural cause, such as spinal stenosis, cancer, or fracture. However, the term “nonspecific” is debated among experts, with some suggesting that a more in-depth evaluation could reveal specific factors contributing to the pain.
Physiatrists, also known as physical medicine and rehabilitation physicians, play a crucial role in diagnosing various pain conditions and guiding individuals through therapies to manage back pain effectively.
It’s important to note that the reporting of socioeconomic and demographic information in the included studies was inconsistent and poor. As a result, the study’s findings may not universally apply to all individuals dealing with chronic, nonspecific low back pain. Individualized assessments by healthcare professionals remain essential for accurate diagnosis and tailored treatment plans.
How do psychological therapies help with pain?
Psychological therapies play a crucial role in helping individuals manage chronic pain by addressing negative thoughts, changing pain perception, and modifying attitudes and behaviors. Various approaches aim to reduce pain-related distress, including:
1. Cognitive Behavioral Therapy (CBT):
- Focuses on identifying and changing negative thought patterns and behaviors associated with pain.
2. Acceptance and Commitment Therapy (ACT):
- Promotes acceptance of pain and encourages individuals to commit to actions aligned with their values, despite the presence of pain.
3. Mindfulness-Based Stress Reduction (MBSR):
- Incorporates mindfulness meditation and awareness techniques to manage pain and stress.
4. Biofeedback:
- Utilizes electronic monitoring to provide individuals with real-time information about physiological processes, helping them learn to control functions like muscle tension.
5. Pain Reprocessing Therapy (PRT):
- Focuses on changing beliefs about the causes and consequences of chronic low back pain, potentially providing substantial and long-lasting pain relief.
Recent studies, such as the evaluation of PRT, highlight the effectiveness of psychological treatments in achieving significant and enduring pain relief. The interconnected nature of the brain and body underscores the importance of addressing both physical and psychological aspects of pain. Integrative approaches, including functional restoration programs and collaboration with pain psychologists, can empower individuals to better understand and manage chronic pain by addressing all contributing factors.
