Psychological Approach Helps Back Pain

Most people suffer from low back 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, depression, 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 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."

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 troke: "Low Back Pain Fact Sheet."