Elsevier

The Spine Journal

Volume 8, Issue 1, January–February 2008, Pages 40-44
The Spine Journal

Intervention Review Article
Evidence-informed management of chronic low back pain with cognitive behavioral therapy

https://doi.org/10.1016/j.spinee.2007.10.007Get rights and content

Abstract

Editors' Preface

The management of chronic low back pain (CLBP) has proven to be very challenging in North America, as evidenced by its mounting socioeconomic burden. Choosing amongst available nonsurgical therapies can be overwhelming for many stakeholders, including patients, health providers, policy makers, and third-party payers. Although all parties share a common goal and wish to use limited health-care resources to support interventions most likely to result in clinically meaningful improvements, there is often uncertainty about the most appropriate intervention for a particular patient. To help understand and evaluate the various commonly used nonsurgical approaches to CLBP, the North American Spine Society has sponsored this special focus issue of The Spine Journal, titled Evidence-Informed Management of Chronic Low Back Pain Without Surgery. Articles in this special focus issue were contributed by leading spine practitioners and researchers, who were invited to summarize the best available evidence for a particular intervention and encouraged to make this information accessible to nonexperts. Each of the articles contains five sections (description, theory, evidence of efficacy, harms, and summary) with common subheadings to facilitate comparison across the 24 different interventions profiled in this special focus issue, blending narrative and systematic review methodology as deemed appropriate by the authors. It is hoped that articles in this special focus issue will be informative and aid in decision making for the many stakeholders evaluating nonsurgical interventions for CLBP.

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

References (27)

  • E.T. Dowd

    Cognition and the cognitive revolution in psychotherapy: promises and advances

    J Clin Psychol

    (2004)
  • D.C. Turk et al.

    The cognitive-behavioral approach to pain management

  • R.J. Gatchel et al.

    Pain management

  • Cited by (0)

    Support in part was provided (R.J.G.) by the Department of Defense (grant number DAMD 17-03-1-0055).

    View full text