Patients looking for nonoperative ways to treat chronic low back pain (CLBP) might want to consider cognitive behavioral therapy (CBT). CBT is a way to change behavior by changing the way a patient thinks about his or her back pain. In this review of CBT, experts in psychology at the University of Texas (Arlington) offer a summary of CBT.
Patients find many different ways to cope with illness, injury, and disease. But these coping skills and the emotions, thoughts, and behaviors that come with them aren't always healthy or rational. CBT addresses the psychosocial aspects of CLBP and can help reduce pain and anxiety that comes with it.
Many different techniques are used as a part of CBT. These can include imagery, positive self-talk, biofeedback, and various methods of self-induced relaxation. Patients are taught how to set realistic goals and reach them. Negative and self-defeating thoughts are identified. The patient is educated about ways to overcome them.
Breaking the cycle of maladaptive coping behaviors isn't easy. Many patients with CLBP also have issues around alcohol and other drug abuse. Depression and anxiety can lead to withdrawal from daily activities, including work. But CBT can be successful if patients are motivated and willing to do their homework exercises between sessions.
Studies show that CBT works well when it is part of a multidisciplinary team approach to pain management. Treatment that focuses on both the biologic and psychosocial aspects of pain may cost more in the short-term, but they have better long-term results. Patients have fewer relapses and visit their physicians less often than those who are treated by a single approach of surgery, medications, exercise, or massage, etc.
Overall research shows that CBT reduces pain and pain behaviors. Activity level increases and social functioning improves. Patients report less distress and anxiety on a daily basis. These improvements may lead to less pain or at least the perception of decreased symptoms and less suffering.
Treatment of chronic pain conditions has moved away from monotherapy (a single approach to pain). CBT should be combined with other treatment tools such as physiotherapy to address deconditioning, instability, and loss of function that further contribute to the chronic pain cycle. Medications for pain relief and other treatment methods that address all aspects of biologic, psychologic, and social factors are still important.
Robert J. Gatchel, PhD, ABPP, et al. Evidence-Informed Management of Chronic Low Back pain with Cognitive Behavioral Therapy.In The Spine Journal. February 2008. Vol. 8. No. 1. Pp. 40-44.
