Can Low Back Pain Be Managed Without Surgery or Drugs?

Laird Harrison

Disclosures

December 07, 2016

In This Article

Two Approaches to Pain Management

In recent years, therapists have tried melding the two approaches, in what has been the "third wave" of CBT techniques.[3]

To see whether one modality works better than the other, Dr Cherkin and colleagues recruited patients with at least 3 months of chronic back pain from Group Health, a large healthcare system in Washington State, for a randomized clinical trial.[2]The investigators excluded people with specific diagnoses—those with ruptured discs, spinal stenosis, fractures, or tumors represent different patient populations and may not be as responsive to mind/body therapies—and randomly assigned 113 persons to receive usual care, 116 to receive MBSR, and 113 to receive CBT. Collectively, these participants had had back pain for a mean of 7.3 years.

All participants received the medical care they would otherwise have received.[2]Those in the usual-care group were allowed to seek whatever treatment they wished.

The MSRB and CBT groups both met for 2 hours of therapy per week for 8 weeks.[2] Only 59 people in the MBSR group and 64 people in the CBT group were motivated enough to attend at least six sessions. The MBSR program included an optional 6-hour additional retreat, which 30 people attended.

Participants in both the experimental groups received workbooks, motivational audio compact discs, and instructions for home practice.[2]

Eight instructors with 5-29 years of experience administered MBSR in the study. Four licensed PhD-level psychologists who were experienced in group and individual CBT for chronic pain administered CBT.[2]

After 26 weeks, both the CBT and MBSR groups showed more improvement than the usual-care group in measures of pain, disability, and depression.[2] For example, on the Roland Morris Disability Questionnaire, 60.5% of participants in the MBSR group experienced meaningful improvement, which was statistically similar to the 57.7% of the CBT group but greater than the 44.1% of the usual-care group who experienced improvement.

The results for improvement in pain bothersomeness were similar: 43.6% for MBSR, 44.9% for CBT, and 26.6% for usual care.[2] At 52 weeks, CBT was no longer superior to usual care, whereas MBSR still was.

The researchers are now trying to figure out whether CBT and MBSR work by the same mechanism. "I'm not sure there are a lot of differences between treatments that appear roughly similar to patients," says Dr Cherkin.

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