An ailment that can strike at any time, chronic back pain is one of the leading causes of disability.
Chronic back pain contributes to everything from sleepless nights and depression to missed work and reduced income.
Painkillers and rest are two popular approaches taken to ease its symptoms. However, new research from Goethe University Frankfurt has revealed that combining tailored exercises with cognitive behavioral therapy (CBT) might be an optimal approach to treating chronic back pain.
Over 10,000 people with chronic lower back pain participated in 58 randomised control trials, the results of which were examined in the study. The effectiveness of three different therapy modalities—standard exercise, tailored treatment, and individualised care with CBT—was examined by the researchers. Standard exercise regimens include Pilates exercises, however individualised care entails specially designed exercises developed in collaboration with a medical specialist, such as a physiotherapist.
CBT, on the other hand, is a talking treatment meant to change a person’s habits and thoughts. Due to its greater attention to the patient, their needs, and their suffering, individualised care has been found to be 38% more effective at relieving pain than conventional exercise treatments. However, when researchers examined the combined effects of CBT and customised care, or a “multimodal approach,” the advantages were astounding: 84% higher than standard treatment alone.
Dr. Johannes Fleckenstein, from the Institute of Sports Sciences at Goethe University Frankfurt and co-author of the research, revealed the benefits were optimal in the shorter term (three months or less). However, he noted, “at one year, effects can still be observed — [they are just] smaller. Pain and disability are still reduced compared to the initial level.” “I am sure that effects are stronger in groups where a minimum level of counseling is obtained through the year or in patients that continued with CBT training,” Fleckenstein hypothesized.
One reason improvements may have declined? The data didn’t allow the researchers to see whether participants adhered to treatment — and consistency is critical.
“In CBT, you’ll work with a therapist to identify unhelpful thoughts and behaviors and replace them with balanced thoughts and healthy behaviors,” Dr. Whitley Lassen, clinical director of mental health services at digital care app K Health, said
Numerous types of talk therapies are available, such as psychoanalysis, which delves into unconscious thoughts and feelings as a route for self-improvement.
In comparison, “CBT is not such an extended process” and doesn’t focus on “the introspective journey,” explained Laurie Singer, a board-certified behavior analyst and founder of Laurie Singer Behavioral Services. Instead, “it’s a swift, satisfactory correction of a single issue, or multiple combined issues, that have taken control of a life,” she added.
How does CBT work to treat pain?
Numerous studies have already shown how CBT alone can improve back pain sufferers’ experiences. For instance, CBT improves attitudes and reduces pain-related catastrophizing thoughts in a study of persons with chronic back pain (when a person expects the worst will happen). Following CBT, individuals’ attitudes toward pain and fear-avoidance considerably decreased, according to a different study. It’s important to understand that CBT won’t make your discomfort go away, said Lassen in his opening statement. Instead, she claimed, it can assist you in altering negative or counterproductive thought patterns related to pain and how you react to it.
Following CBT, participants reported reduced anxiety about moving around, according to the study’s researchers. So how did CBT contribute to this result? According to Lassen, having the problematic idea “I can’t cope with the pain” may make negative feelings like anxiety worse. But with CBT, you can shift your perspective from, “I can’t cope with the pain,” to, “I have experienced suffering before and survived.” I can handle this,” she added. Your response to the pain will ultimately change as a result of this attitude adjustment. Distraction is another tool that CBT offers.
You are more likely to experience and register pain if you are extremely aware of and scared of it, according to Dr. Peggy Loo, a professional psychologist and the director of Manhattan Therapy Collective. Instead, CBT trains you to concentrate on more uplifting thoughts, which might help you completely forget about discomfort because your attention is diverted. CBT can help physiologically because the mind and body are inextricably linked.
“By reducing stress and distress, you’re able to calm your stress responses down,” Flaxen explained. “Which, in turn, can reduce the amount of pain experienced.”
It’s possible for feelings and concerns to become more pronounced when you try to ignore or repress them.
According to Flaxen, CBT enables you to realise that you are in control of your thoughts and to concentrate on objectives and constructive behaviours. It’s a process that empowers.
In fact, the study participants were able to accept that being in pain doesn’t necessarily make them helpless, according to the researchers, who used a multimodal strategy. Although CBT can ultimately help with pain management, Loo made it clear that the therapy should not be used in place of competent medical care. I’d advise a CBT therapist to work closely with a patient’s doctor to distinguish between what qualifies as pain management and what could need additional medical attention, she said.
Is CBT effective for all people? Like any strategy, CBT can help with some parts of pain management, but not everyone will benefit from it, according to Flaxen. CBT alters the way people think about pain rather than the actual source of it. As a result, some situations may call for more drastic action, such as surgery to treat a slipped disc. If CBT is something that could help you, experts believe that a lot of its success comes from dedication and attitude. CBT is “not an overnight fix,” according to Flaxen, thus it must be used for a specific amount of time. People often attend 5 to 20 sessions to treat chronic pain.
A Japanese study revealed additional barriers could include:
- Poor language/communication skills
- Low emotional value judgment
- The tendency of medical dependency
- Excessive focus on searching for pain
- ADHD
- Fantasy/distortion of actual experience
Loo advised looking through listings of CBT therapists to get started, such as the website of the Association for Behavioral and Cognitive Therapies. Directories let you search by specialty, so you may target the search for therapists who specialise in treating pain. Studies show that web-based therapy is just as successful as in-person CBT sessions, and there are many free and inexpensive online options. CBT sessions can be done in person.
Parvathy Sukumaran 
