Psychological Approach Helps Back Pain

Psychological Approach Helps Back Pain

Researchers Say Techniques Like Biofeedback and Relaxation Training Are
Effective By Salynn Boyles
WebMD Medical News Reviewed By Louise Chang, MD
on Friday, December 22, 2006


Dec. 22, 2006 -- Most people suffer from low back painback pain at some
point in their lives, but people with long-lasting pain often get little
relief from the most widely recommended treatments.

Now a new research review shows that focusing on the mind may be the best
approach to treating the back for many people with chronic low back pain.

Researchers reported that psychological interventions such as biofeedback,
relaxation techniques, and cognitive behavioral therapy can be even more
effective than more traditional treatments for reducing back pain.

Biofeedback allows people to learn to control body functions such as heart
rate and muscle tension. Cognitive behavioral therapy teaches people ways to
think and act to help cope with pain.

The researchers came to their conclusions after reviewing more than 20
studies that explored the value of psychologically based therapies for the
treatment of low back pain.

"These therapies are increasingly recommended, but they are still not
utilized as much as they could be," researcher Robert Kerns, PhD, tells
WebMD. "The extent to which patients are referred for these treatments is
inconsistent with the strength of the medical findings."

Kerns is chief of the psychology service at the VA Connecticut Healthcare
System.

Studies on Back Pain

The 22 trials included in the analysis were originally reported between 1982
and 2003. Only patients with chronic back pain -- lasting at least three
months or frequent recurrent pain over three months -- took part.

Among 13 studies that reported pain duration, there was an average duration
of seven and a half years.

The psychological interventions included self-administered techniques such
as hypnosis, biofeedback, and relaxation; cognitive behavioral therapy; and
other approaches that involved continued counselor support.

Twelve pain-related outcomes were considered, including pain intensity, pain
interference, depressiondepression, utilization of health care services, and
health-related quality of life.

The combined analysis found that psychological interventions were most
effective for reducing pain intensity. Significant improvements were also
seen in health-related quality of life, work-related disability, and
depression.

Cognitive behavioral therapy and self-administered treatments such as
biofeedback and relaxation training were found to work best. Treatment
approaches that combined psychological interventions with more traditional
therapies were also found to be particularly effective for reducing the
impact of pain on daily activities.

The research analysis appears in the January issue of the journal Health
Psychology.

Heavy Spending on Back Pain

Kerns tells WebMD that psychological approaches to back pain managementpain
management are often less costly than traditional treatments.

Americans spend at least $50 billion annually on these treatments, according
to the National Institute of Neurological Disorders and Stroke.

"Surgery, opioids, nerve blocks, spinal cord stimulators, implantable drug
delivery systems -- every one of those particular alternatives is much more
expensive and has poorer or at best equal outcomes compared to
rehabilitation programs that include psychological components," pain
research expert Dennis Turk, PhD, says in a news release.

Turk is a professor of anesthesiology and pain research at the University of
Washington in Seattle.

"The paradox is that, despite data on the effectiveness of psychological
interventions, insurers are less willing to pay for them."


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SOURCES: Hoffman, B.M. Health Psychology, January 2007; online edition.
"Psychological Treatments Improve Outcomes for Back Pain Sufferers," Center
for the Advancement of Health news service, Dec. 22, 2006. Robert D. Kerns,
PhD, chief psychology services, VA Connecticut Healthcare System, West
Haven, Conn. National Institute of Neurological Disorders and Stroke: "Low
Back Pain Fact Sheet."