Intervention Review ArticleEvidence-informed management of chronic low back pain with cognitive behavioral therapy
Section snippets
Terminology
The major goal of cognitive behavioral therapy (CBT) is to replace maladaptive patient coping skills, cognitions, emotions, and behaviors with more adaptive ones. From a biopsychosocial perspective, CBT alone does not address all of the important variables potentially contributing to chronic low back pain (CLBP) (eg, biological factors) but may improve care for patients with psychological comorbidities. The addition of even a very brief schedule of CBT to usual care from primary care physicians
Mechanism of action
It is important to note that CBT does not directly address the physiological component of pain in CLBP. However, the requisite reframing of maladaptive thoughts and coping strategies can lead to a decrease in distress, which may, in turn, reduce the pain experience to some degree [8]. Again, it should be noted that CBT interventions proceed from the view that an individual's interpretation, evaluation, and beliefs about his or her health condition and coping repertoire, with respect to pain and
Review methods
Searches of the CBT and CLBP literature during the past decade were conducted for this purpose, using Medline, Psychlit, and The Cochrane Database of Systematic Reviews. Studies reporting treatment outcome data for variables such as self-reported pain and disability, function, health-care utilization and cost, medication use, insurance claims, and work factors were evaluated. When available, conventional intervention treatments, such as surgery, were used as the benchmark against which the
Harms
The side effects and adverse events related to this intervention are unknown.
Summary
To date, the literature indicates that CBT is an effective component in the overall treatment of CLBP. As noted earlier, the biopsychosocial approach to chronic pain management has moved away from the outdated view that monotherapy is the best approach to achieve overall therapeutic improvement. Multiple factors—biological, psychological, and social—must be simultaneously addressed and CBT serves an effective role in dealing with the psychosocial component of CLBP. However, it needs to be
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Support in part was provided (R.J.G.) by the Department of Defense (grant number DAMD 17-03-1-0055).