Comparison of cognitive-behavioral group treatment and an alternative non-psychological treatment for chronic low back pain

Abstract

This study was designed to investigate the relative efficacy of cognitive-behavioral group treatment, including relaxation training, in comparison with a control condition in a sample of 20 outpatients with chronic low back pain. Subjects in both conditions also received the same physiotherapy back-education and exercise program. The control condition included a control for the attention of the therapist in the cognitive-behavioral treatment. The combined psychological treatment and physiotherapy condition displayed significantly greater improvement than the attention-control and physiotherapy condition at post-treatment on measures of other-rated functional impairment, use of active coping strategies, self-efficacy beliefs, and medication use. These differences were maintained at 6 month follow-up on use of active coping strategies and, to a lesser degree, on self-efficacy beliefs and other-rated functional impairment.

Imperfect placebos are common in low back pain trials: a systematic review of the literature

“…Nicholas et al [111] Group discussion hB; Fi Expectation scale: no significant differences between groups at baseline; higher expectations in experimental group after treatment (P \ 0.05)…”

“…For simplicity, each comparison was treated as an individual trial. Trials reported on the following categories of interventions: acupuncture (10 trials) [25,42,73,74,85,95,99,104,106,128], back school (2 trials) [11,28], behavioural (7 trials) [10,21,62,111,130,132,133], electrotherapy (20 trials) [8, 15, 25, 27, 37, 49-51, 54, 57, 63, 69, 76, 77, 89, 94, 107, 122, 137, 143], exercise (10 trials) [29,37,43,48,50,59,67,116,131,136], heatwrap therapy (2 trials) [109,110], insoles (1 trial) [127], magnets (1 trial) [33], massage (1 trial) [116], neuroreflexotherapy (1 trial) [93] [16,117,129]. Trial characteristics are presented in Table 1.…”

Brief intervention, physical exercise and cognitive behavioural group therapy for patients with chronic low back pain (The CINS trial)

“…Similar treatments have previously been shown effective when given alone both in a primary care setting (Lamb et al, 2010) and in a specialist health care setting (Nicholas et al, 1992). The group CBT in our study was administered in 7 sessions while the PE involved 36 sessions.…”

Auto-eficácia e sintomas depressivos em doentes com dor crônica

“…Um estudo desenvolvido por Nicholas et al (1992), para verificar a eficácia do tratamento cognitivo-comportamental que incluía treino de relaxamento em comparação com um grupo controle para pacientes com dor lombar crônica, constatou melhora significativa na funcionalidade, no uso de estratégias ativas de coping e nas crenças de auto-eficácia, além de redução no uso de medicamentos. Essas diferenças se mantiveram no seguimento, após 6 meses para o uso de estratégias de coping e em menor grau para as crenças de auto-eficácia e para funcionalidade.…”