Pain in the back? Talk your way to recovery

Cognitive therapy can help reduce physical pain, researchers claim

Doctors have found a novel way of curing a bad back – with talk.

Patients with chronic back pain who received cognitive behaviour therapy were almost twice as likely to recover as those who were told to keep active and use painkillers – the more conventional treatment.

Cognitive behaviour therapy (CBT) is established as the most effective of the talking treatments and has revolutionised the way doctors approach psychological conditions such as depression and anxiety. But it is not usually associated with physical ailments such as back pain.

The technique involves helping patients to break habitual ways of seeing things and to think positively instead of negatively.

Zara Hansen, a member the research team from the University of Warwick said: "We are not saying back pain is all in the mind. It is very much a physical problem but the way you understand it affects the way you manage it.

"When a person gets pain in their back they may well think they have harmed themselves or caused injury so they back away from more activity and movement, become more de-conditioned and fearful of pain. This is the picture we see again and again with back pain, a very common cycle of avoidance. It is the most natural thing to do but, unfortunately, it drives people down a path of more stiffness and more pain."

The researchers recruited 700 patients from 56 general practices who had suffered back pain of at least moderate intensity for at least six weeks. Two thirds were allocated to receive six sessions of group cognitive therapy, with eight patients per group on average, and the outcome was compared with the remaining third.

The results showed that after one year, 59 per cent of those that received the cognitive therapy said they had recovered, compared with 31 per cent of the control group. Objective measures of pain also showed improvement was doubled among those who had the therapy. The findings are published in the Lancet.

Ms Hansen said: "These are quite amazing results. We have shown that cognitive behaviour therapy is twice as effective as a single session of advice and at least as effective as manipulation, exercise therapy or acupuncture but at half the cost. The problem with many treatments is that they only work short term. We have shown improvement was sustained at 12 months, suggesting a long-term effect."

Back pain is the third most common reason for consulting a doctor, after headaches and tiredness, but GPs often cannot find a specific cause. An estimated £1.6bn is spent on treating back pain in Britain each year and billions more are lost in days off work.

GPs are taught to reassure patients that they will get better and to advise them to keep active and avoid bed rest (which tends to make the condition worse), and to take a couple of paracetamol when required.

The National Institute for Clinical Excellence, which issued guidance on treatments for back pain last year, said it had been unable to draw conclusions about psychological approaches because of a paucity of evidence. The University of Warwick researchers say their findings help fill that gap.

An editorial in the Lancet said the results were "impressive" and suggested the therapy was "an excellent option" for back pain sufferers.



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