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Lower back pain can be treated with 'talking therapy'

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An innovative form of talking therapy could help people suffering from chronic lower back pain, according to new research.

A study testing the use of contextual cognitive behavioural therapy (CCBT), which focuses on helping people live life to the full despite ongoing pain, found participants valued the approach.

“Combining physical and psychological approaches could be the way forward to treat this common, often disabling condition more effectively”

Stephen Simpson

But both patients and clinicians involved in the research by Royal Holloway, University of London, said they would prefer a combination of both talking therapy and physiotherapy.

Lower back pain is one of the most common health problems in the UK and affects many nurses. As well as enduring physical pain, many sufferers also experience related psychological distress.

The study, published online in the journal BMC Musculoskeletal Disorders and funded by Arthritis Research UK, set out to test whether CCBT could be a credible and acceptable treatment.

It involved 89 people with lower back pain and high levels of psychological distress who tended to avoid everyday activities.

Participants were chosen at random to receive either one-to-one CCBT delivered by trained psychologists or physiotherapy group exercise sessions.

“Interestingly, many patients who took part, as well as several of the clinicians involved thought the best treatment was a combination of both physiotherapy and CCBT,” said Professor Tamar Pincus from Royal Holloway’s department of psychology.

“Patients and clinicians felt the best solution would be to deal with both physical and psychological problems,” she said.

Another key finding was the fact patients preferred the idea of one-to-one talking therapy as opposed to group sessions.

“We know that for some people with chronic lower back pain psychological distress is a major factor and therefore there is a significant challenge to find effective treatments,” added Stephen Simpson, director of research and programmes at Arthritis UK.

“This study has shown that combining physical and psychological approaches could be the way forward to treat this common, often disabling condition more effectively,” he said.

Professor Pincus and her team are now planning a larger clinical trial to explore whether a combination of physiotherapy and psychology can help improve outcomes for patients and reduce long-term treatment costs.

  • 7 Comments

Readers' comments (7)

  • Apparently, CBT can treat just about anything.

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  • I've just had a practice talking to myself, because on reading the headline - and not the article - I assumed it related to abdominal strength. Anyhow, for that reason, I felt it ease my back as I tightened my abdo (to speak). So, is having a chat about things akin to abdo-tightening, or is having a chat quite nice so makes you feel better and loosens the tightness because someone has listened...because they are paid to? I'm afraid I know someone is paid to chat, so I would find it insincere, so would excuse myself. Then perhaps I would be classed as having problems with communication, authority, fluorescent lighting, pencils, etc. I look forward to the follow-up/further research. I'm still happy about the chocolate article!

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  • Anonymous, 18-june is making the big mistake of devaluing the skill and commitment of trained therapists and effective psychotherapy.

    I saw my wife transformed by the latter when she was debilitated by severe, chronic pain.

    Lets move away from calling the varying forms of psychotherapy "talking therapy" because that doesn't do them justice and leads to the above misconceptions.

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  • perhaps mindfulness and quackery would work as well

    it can't be proper pain if you can just talk people out of it!

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  • The comments of 'anonymous' 18th and 21st June suggest a lack of understanding about the psychological factors involved in pain. It is not 'just having a chat' and the assumption that psychological therapy is just about 'someone listening' devalues the discipline (as well as the experience of those in pain) and makes 'anonymous' appear flippant and ignorant.
    There is an extensive literature on the psychological mechanisms of pain - much of chronic pain stems from issues related to how we think about and interpret pain. To take a relatively straightforward example, someone who is excessively worried about the effect of movement when they are in pain may restrict their movement. Over time this restricted movement can lead to more pain and thus more movement restriction. It is necessary to understand how people think about their pain and the psychological factors that influence how they manage this. In the example above, it is only by understanding why the patient is restricting their movement and tackling the negative cognitions here that progress can be made. As anyone who has read about or worked in the area of chronic pain will understand there often is more at play than 'just' physiological damage. Unfortunately, negative comments about the psychological approach suggest that such treatments assume 'it is all in the patient's mind' can be extremely damaging to treatment attempts, with many patients becoming defensive when it is suggested that there might be a psychological factor involved. It is time we tackled this stigma head on and start to understand the power that our brain has in these situations - and the only way forward is education.

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  • Anonymous, 18-june is making the big mistake of devaluing the skill and commitment of trained therapists and effective psychotherapy.

    I saw my wife transformed by the latter when she was debilitated by severe, chronic pain.

    Lets move away from calling the varying forms of psychotherapy "talking therapy" because that doesn't do them justice and leads to the above misconceptions.

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  • Unfortunately anyone without 'inside knowledge' might construe that the title on this page indicates the back pain treated is not 'real' pain. However many of us have seen how hypnotism can allow painful procedures to be performed without any anaesthetic and therefore understand that 'pain' is difficult to define. Surely the support we give to patients during uncomfortable procedures to try to alleviate some of their discomfort is a minor form of 'talking therapy'. Therefore I think combining psychological and physical approaches for the many patients whose lives are blighted by lower back pain must surely be an improvement.

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