New research from Royal Holloway, University of London has found that a new form of talking therapy is a credible and promising treatment for people with chronic low back pain who are also suffering from related psychological stress.
Professor Tamar Pincus from the Department of Psychology also found that patients preferred a combination of talking therapy and physiotherapy to address both the psychological and physical aspects of their back pain.
Low back pain is one of the most common and costly health problems in the UK and research is starting to reveal the important role that psychological factors play in managing it.
A new treatment, contextual cognitive behavioural therapy (CCBT), is particularly promising, as it focuses on accepting pain that cannot be cured, and learning to live life to the full amid the pain.
Researchers carried out a feasibility study to test the credibility and acceptability of a type of talking therapy called contextual cognitive behavioural therapy compared to physiotherapy in 89 patients with low back pain. Patients were randomised to receive CCBT or physiotherapy over an 18 month period for eight weeks. CCBT was delivered by trained psychologists on a one-to-one basis, and comprised up to eight sessions. Physiotherapy involved back to fitness group exercise exercises.
Patients participating had low back pain for at least three months and high levels of psychological distress, avoided everyday activities and were known as ‘fear avoidant.’
Professor Tamar Pincus, said: “Our study found that CCBT is acceptable to patients, but interestingly many patients who took part, as well as several of the clinicians involved — both psychologists and physiotherapists — thought the best treatment was a combination of both physiotherapy and CCBT.
Patients and clinicians felt the best solution would be to deal with both physical difficulties and psychological problems.”
Another important finding from the study was that patients reported that they wanted their talking therapy to be on a one-to-one basis with a psychologist, which contrasts with current trends of introducing psychology group as a group activity led by physiotherapists.
The research was published in the BMC Musculoskeletal Disorders journal online and was funded by Arthritis Research UK.
Dr Stephen Simpson, director research and programmes at the charity Arthritis Research UK said: “We know that for some people with chronic low back pain psychological stress is a major factor, and therefore there is a significant challenge to find effective treatments. This pilot study has shown that combining physical and psychological approaches could be the way forward to treat this common, often disabling condition more effectively.”
Professor Pincus and her team are now planning a larger clinical trial to explore whether the combination of physiotherapy and psychology will improve outcomes for patients and reduce treatment costs in the long term. The study is done by University of Royal Holloway London.
