The purpose of this meta-analysis of randomized controlled trials was to evaluate the efficacy of psychological interventions for adults with noncancerous chronic low back pain (CLBP). The authors updated and expanded upon prior meta-analyses by using broad definitions of CLBP and psychological intervention, a broad data search strategy, and state-of-the-art data analysis techniques. All relevant controlled clinical trials meeting the inclusion criteria were identified primarily through a computer-aided literature search. Two independent reviewers screened abstracts and articles for inclusion criteria and extracted relevant data. Cohen's d effect sizes were calculated by using a random effects model. Outcomes included pain intensity, emotional functioning, physical functioning (pain interference or pain-specific disability, health-related quality of life), participant ratings of global improvement, health care utilization, health care provider visits, pain medications, and employment/disability compensation status. A total of 205 effect sizes from 22 studies were pooled in 34 analyses. Positive effects of psychological interventions, contrasted with various control groups, were noted for pain intensity, pain-related interference, health-related quality of life, and depression. Cognitive-behavioral and self-regulatory treatments were specifically found to be efficacious. Multidisciplinary approaches that included a psychological component, when compared with active control conditions, were also noted to have positive short-term effects on pain interference and positive long-term effects on return to work. The results demonstrated positive effects of psychological interventions for CLBP. The rigor of the methods used, as well as the results that reflect mild to moderate heterogeneity and minimal publication bias, suggest confidence in the conclusions of this review.
"Otro aspecto de la intervención son las técnicas cognitivas que ayudan al paciente a cortar la espiral de miedo-evitación intentando controlar sus pensamientos y emociones negativas así como el desarrollo de conductas de afrontamiento adaptativas. Todas estas técnicas han demostrado su eficacia en el tratamiento de la lumbalgia (Casado, Moix y Vidal, 2008; Chou y Fuman, 2007; Hoffman, Papas, Chatkoff y Kerns, 2007). "
[Show abstract][Hide abstract] ABSTRACT: Objectives: This pilot study investigated the feasibility and clinical utility of implementing a novel, evidence-informed, interdisciplinary group intervention—Mindfulness Based Functional Therapy (MBFT)—for the management of persistent low back pain (LBP) in primary care. MBFT aimed to improve physical and psychological functioning in patients with persistent LBP.
Design: A single-group repeated measures design was utilized to gather data about feasibility, effect sizes, clinically significant changes and patient satisfaction.
Setting: A community sample of 16 adults (75% female), mean (SD) age 47.00 (9.12) years (range 26–65 years), with mean (SD) LBP duration of 8.00 (9.00) years participated, using a simulated primary care setting at Curtin University in Australia.
Intervention: MBFT is an 8-week group intervention co-facilitated by psychology and physiotherapy disciplines. Content includes: mindfulness meditation training, cognitive-functional physiotherapeutic movement retraining, pain education, and group support.
Main outcome measures: Several validated self-report measures were used to assess functional disability, emotional functioning, mindfulness, pain catastrophizing, health-related quality of life at baseline, post-intervention, and 6 months follow-up.
Results: Adherence and satisfaction was high, with 85% of participants highly satisfied with MBFT. Clinical significance analysis and effect size estimates showed improvements in a number of variables, including pain catastrophizing, physical functioning, role limitations due to physical condition, and depression, although these may have occurred due to non-intervention effects.
Conclusions: MBFT is feasible to implement in primary care. Preliminary findings suggest that a randomized controlled trial is warranted to investigate its efficacy in improving physical and emotional functioning in people with disabling persistent LBP.
Frontiers in Psychology 08/2014; 5:839. DOI:10.3389/fpsyg.2014.00839 · 2.80 Impact Factor
"In fact, four of the eight nonpharmacologic treatments recommended by the American College of Physicians and the American Pain Society guidelines for persistent back pain include “mind–body” components . One of these treatments, cognitive-behavioral therapy (CBT), includes mind–body components such as relaxation training and has been found to be effective for a variety of chronic pain problems, including back pain [9-13]. CBT has become the most widely applied psychosocial treatment for patients with chronic back pain. "
[Show abstract][Hide abstract] ABSTRACT: Background
The self-reported health and functional status of persons with back pain in the United States have declined in recent years, despite greatly increased medical expenditures due to this problem. Although patient psychosocial factors such as pain-related beliefs, thoughts and coping behaviors have been demonstrated to affect how well patients respond to treatments for back pain, few patients receive treatments that address these factors. Cognitive-behavioral therapy (CBT), which addresses psychosocial factors, has been found to be effective for back pain, but access to qualified therapists is limited. Another treatment option with potential for addressing psychosocial issues, mindfulness-based stress reduction (MBSR), is increasingly available. MBSR has been found to be helpful for various mental and physical conditions, but it has not been well-studied for application with chronic back pain patients. In this trial, we will seek to determine whether MBSR is an effective and cost-effective treatment option for persons with chronic back pain, compare its effectiveness and cost-effectiveness compared with CBT and explore the psychosocial variables that may mediate the effects of MBSR and CBT on patient outcomes.
In this trial, we will randomize 397 adults with nonspecific chronic back pain to CBT, MBSR or usual care arms (99 per group). Both interventions will consist of eight weekly 2-hour group sessions supplemented by home practice. The MBSR protocol also includes an optional 6-hour retreat. Interviewers masked to treatment assignments will assess outcomes 5, 10, 26 and 52 weeks postrandomization. The primary outcomes will be pain-related functional limitations (based on the Roland Disability Questionnaire) and symptom bothersomeness (rated on a 0 to 10 numerical rating scale) at 26 weeks.
If MBSR is found to be an effective and cost-effective treatment option for patients with chronic back pain, it will become a valuable addition to the limited treatment options available to patients with significant psychosocial contributors to their pain.
Clinicaltrials.gov Identifier: NCT01467843.
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