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| |  Cognitive Behavioural Therapy Improves Back Pain NEW YORK -- February 25, 2010 -- Group cognitive behavioural therapy (CBT) can reduce low-back pain, and at a low cost to the health-care provider. Moreover, the improvement was sustained at 1 year after the start of treatment, according to a study published in this week’s issue of The Lancet. Persistent low-back pain is increasingly common, and it can be debilitating, ranking as one of the top 3 most disabling conditions in the developed world. Since it is so common, back pain is also costly to treat. Sarah E Lamb, MD, Warwick Clinical Trials Unit, Warwick Medical School, University of Warwick, Coventry, United Kingdom, and colleagues undertook a randomised controlled trial of 701 patients with troublesome subacute or chronic low-back pain from general practices across England. The researchers’ goal was to determine whether group cognitive behavioural therapy would offer any additional benefit to best practice advice in primary care. This advice included guidance on staying active and appropriate use of pain medication. The patients were then randomly assigned to 2 groups: 468 participants were given up to 6 sessions of group CBT, and 233 controls were given no additional treatment. Eighty-five percent of participants in each group completed the study. Primary outcomes were the change at 1 year from baseline in Roland Morris disability questionnaire and modified Von Korff scores, both of which measure pain and disability. The team found that at 1 year, CBT had significantly improved both disability scores. The change from baseline in the Roland Morris questionnaire was 2.4 points in the CBT group compared with 1.1 points in controls. The Von Korff score changed by 13.8% in the CBT group and 5.4% in controls. Crucially, the treatment was cost-effective. The cost per quality-adjusted life-year was about half that of competing treatments such as acupuncture. “Effective treatments that result in sustained improvements in low-back pain are elusive,” the authors wrote. “This trial shows that a bespoke cognitive behavioural intervention package, BeST, is effective in managing subacute and chronic low-back pain in primary care. The short-term effects (<=4 months) are similar to those seen in high-quality studies and systematic reviews of manipulation, exercise, acupuncture, and postural approaches in primary care.” The authors believe that the treatment could have a wide applicability because the participants were representative of the ethnic mix of the UK, and they came from a mix of rural and urban areas. They also noted that 95% of the CBT session time was directed towards achieving psychological goals rather than on supervised exercise. “A bespoke cognitive behavioural intervention package for low-back pain has an important and sustained effect at 1 year on disability from low-back pain at a low cost to the health-care provider,” the authors concluded. In an accompanying comment, Laxmaiah Manchikanti, MD, Pain Management Center of Paducah, Paducah, Kentucky, said that Lamb and colleagues’ study “showed rather impressive results.” Dr. Manchikanti sounds a note of caution about the routine availability of group CBT for low-back pain in primary care. It “might be feasible in countries with national health-care systems, but not in a country like the USA.” He concluded that “the results suggest that cognitive behavioural therapy is an excellent option for primary care physicians before they seek specialty consultations for their patients.”
SOURCE: The Lancet
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