A Study Sheds Light On the Role of Psychological Therapy in Lower Back Pain

December 1, 2022

Summary: Although doctors know that pain management psychologists can help manage chronic low back pain along with physiotherapy. However, they do not know to what degree it helps and what kind of psychological therapy is better. The new study, a meta-analysis, found that cognitive behavior therapy and pain education are among the superior psychological interventions that provide long-term chronic pain treatment, fear reduction, and function enhancement. In addition, psychological therapy is effective and safe to use along with physiotherapy.

Researchers from the University of Sydney, Australia, say that their study shows that there is sound evidence in support of using psychological therapy along with physiotherapy in those living with intense lower back pain. In addition, the study’s findings help better describe the role of pain management psychologists in low back treatment.

Millions of adults live with intense, chronic lower back pain, and treatment fails to help sufficiently in many cases. Hence, it is a common practice to combine different treatment modalities. Chronic low back pain is a condition when low back pain lasts for more than 12 weeks. Even severe sciatica back pain is confused with lower back pain.

The relationship between psychological stress and chronic painful conditions is well known. It has a dual-sided relationship with chronic pain. Those living with chronic back pain are more likely to have anxiety, depression, and other mental health issues. Conversely, those prone to mental health issues are more likely to have chronic pain.

Though the importance of psychological therapy in managing chronic low back pain has long been identified, guidelines are inconsistent. In addition, it is not clear what kind of psychological therapy to use and when. Thus, doctors have to decide without sufficient evidence and information.

To address this issue, researchers from an Australian university decided to explore the role of different kinds of psychological therapies in chronic pain treatment. For the study, they went through a massive amount of literature. As a result, they identified the five most commonly used psychological therapies in low back pain: behavioral therapy, cognitive behavioral therapy/talking treatment, mindfulness, counseling, pain education programs, and a combination of various psychological therapies.

It was a meta-analysis, which means that they found all the studies using psychotherapy for chronic low back pain and combined their data to find which intervention was better. As a result, they could identify 97 clinical trials with 13,136 participants with 17 different treatment approaches1.

First and foremost, they could confirm that adding psychological therapy to physical therapy was helpful and better than physiotherapy alone.

They found that two kinds of psychological therapies, when used along with physiotherapy, were particularly good for reducing pain. Those are pain education and cognitive behavior therapy. Moreover, the benefits of these therapies were reported even two months after the treatment.

However, among these two methods, it appears that pain education has better outcomes in the long run and is also more sustainable. It showed significant benefits even after six months of the therapy. Pain therapy was especially good for improving physical function. On the other hand, it appears that cognitive behavior therapy was better for reducing pain intensity.

Many people living with low back pain develop fear. They avoid certain activities, thinking it would worsen their back pain. Quite often, these fear beliefs have no scientific reasons. The study found that although cognitive behavior therapy was quite good at reducing fear initially, in the long run, pain education was better for reducing pain fear.

The researchers also found that psychological therapy was quite a safe treatment. None of the 20 studies that mentioned the safety of such a treatment approach reported any side effects. However, researchers have some concerns as they think that many such studies did not pay sufficient attention to adverse effects.

This study was really extensive, exploring the short- and long-term benefits of various psychological interventions for chronic pain treatment. However, researchers did notice that many studies regarding the use of psychological intervention for chronic low back pain were of poor quality, which may influence their meta-analysis quality.

Nonetheless, researchers think that their study could find something important. It could confirm the benefit of psychological interventions in chronic low back pain. Additionally, it could also find that specific treatments like cognitive behavior therapy and pain education are better than others.

By Gurpreet Singh Padda, MD, MBA