Combination of psychological interventions, physiotherapy effective for chronic back pain

Lena Weib

March 31, 2022

2 min read

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The combination of physiotherapy and psychological interventions, including cognitive behavioral therapy and pain education, were effective in treating chronic lower back pain, researchers reported in BMJ.

“Current guidelines provide limited information regarding the specific types of psychological interventions that should be recommended for different clinical outcomes, as well as the comparative longevity of intervention outcomes,” Emma Kwan-Yee Ho, a doctoral candidate at the University of Sydney in Australia, and colleagues wrote.

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“The comparative effectiveness of psychological interventions available for managing chronic low back pain is unknown, potentially contributing to patients and clinicians being uncertain regarding the most optimal choice of treatment.”

Seeking to better understand the effectiveness and safety of specific psychological interventions, Ho and colleagues conducted a systematic review and meta-analysis of 97 randomized, controlled trials. The trials included 13,136 participants and 17 treatment approaches, conducted between 2011 and 2021 in Europe.

Researchers found that in terms of physical function, cognitive behavioral therapy (standardized mean difference = 1.01; 95% CI, 0.58-1.44) and pain education (SMD = 0.62; 95% CI, 0.08-1.17) in combination with physiotherapy resulted in clinical improvements up to 2 months after treatment.

Further, the most sustainable effects of treatment for improving physical function were shown with pain education and physiotherapy at 6 months post-intervention (SMD = 0.63; 95% CI, 0.25-1). No studies investigated long-term effectiveness of pain education and physiotherapy.

“For people with chronic, nonspecific low back pain, psychological interventions are most effective when delivered in conjunction with physiotherapy care (mainly structured exercise),” Ho and colleagues wrote. “Pain education programs and behavioral therapy result in the most sustainable effects of treatment; however, uncertainty remains as to their long-term effectiveness.”

In terms of pain intensity, behavioral therapy (SMD = 1.08; 95% CI, 0.22-1.94), cognitive behavioral therapy (SMD = 0.92; 95% CI, 0.43-1.42) and pain education (SMD = 0.91; 95% CI, 0.37-1.45) in combination with physiotherapy were effective up to 2 months after treatment. Behavioral therapy with physiotherapy was the only intervention to maintain clinically significant effects at 6 months after treatment.

“Findings from our study can be used to inform clearer guideline recommendations regarding the use of specific psychological interventions for managing chronic, nonspecific low back pain and support decision making for patients and clinicians,” the authors wrote.


Ho EK, et al. BMJ. 2022;doi:10.1136/bmj-2021-067718.

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