A pain class not inferior to cognitive behavioral therapy for lower back pain

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September 23, 2021

2 minutes to read

Source / Disclosures

Disclosures: Darnall reports receiving personal honoraria as Chief Science Advisor at AppliedVR unrelated to ongoing research; receive royalties for four books on the treatment of pain authored or co-authored; be Principal Investigator for a Patient-Centered Outcomes Research Institute (PCORI) Pain Research Award; receive consulting fees from Axial Healthcare related to the training of physicians in the prescribing and deprescribing of opioids, unrelated to current work; serving on the board of directors of the American Academy of Pain Medicine and the Institute for Brain Potential; serve as a scientific member of the NIH Interagency Pain Research Coordinating Committee, the CDC Opioid Working Group, and the American Psychological Association Pain Advisory Group; and be a principal investigator for another NIH fellowship. Please see the study for relevant financial information from all other authors.


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According to the results of a randomized clinical trial, a single 2-hour pain management course had as many catastrophic effects on pain as eight 2-hour cognitive behavioral therapy sessions in adults with chronic low back pain.

“Group CBT can offer important elements such as contact with a therapist and peer support”, Hélène Langevin, MD, director of the NIH’s National Center for Complementary and Integrative Health (NCCIH), said in a press release. “But we realize that 16 hours of treatment and the associated costs might be out of reach for some patients. “

According to the data, a single class of pain management provided the same catastrophic pain benefit as multiple sessions of cognitive behavioral therapy in patients with chronic low back pain.
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Della White, PhD, the director of the extramural research program at NCCIH, told Healio Primary Care that “effective and inexpensive treatments” for catastrophic pain are needed to ease the burden on patients and expand access to treatment.

For the study, Beth D. Shit, doctorate, a professor in the Department of Anesthesiology, Perioperative and Pain Medicine at Stanford University School of Medicine, and colleagues randomly assigned 263 adults with a pain score of at least 4 on the scale 10-point pain assessment numerical score and a moderate Pain Catastrophic Scale score of at least 20 on any of the following:

  • A unique 2 hour “Autonomous Relief” course that provided insight into the neurosciences of pain, the concept of mindfulness and CBT. The class was designed to help participants recognize “distressing thoughts and emotions, cognitive reframing, relaxation response exercise, and a self-soothing action plan,” the researchers wrote.
  • A health education course that reflected the empowered response response regarding duration, structure, format and location, and also provided an overview of the warning signs of back pain and when to seek medical attention. doctor, general nutrition and medication.
  • Eight 2-hour CBT sessions that a previous study found taught participants about ‘maladaptive automatic thoughts’, managing their own pain,’ activity pacing and planning, relapse prevention and sustaining gains “.

About half of the study participants were female, over 60% were Caucasian, and the average age was 47.9 years. Participants’ progress was measured after 3 months.

Researchers reported that the enhanced rescue intervention was not inferior to CBT for catastrophic pain (difference from CBT = 1.39 [97.5% CI, to 4.24]). Both empowered relief and CBT were superior to health education intervention (difference between empowered assistance and health education = –5.9 [95% CI, –8.78 to –3.01]; CBT difference from health education = -7.29 [95% CI, –10.2 to –4.38]).

In addition, the declines in catastrophic pain scores among the empowered relief and CBT cohorts were “clinically significant” (empowered relief = -9.12 [95% CI, –11.6 to –6.67]; TCC = –10.94 [95% CI, –13.6 to –8.32] and health education = –4.6 [95% CI, –7.18 to 2.01]), according to the researchers. Although the enhanced relief was inferior to CBT for physical function, the two interventions produced similar benefits for factors such as pain intensity, pain interference, sleep disturbances, depression, and anxiety.

According to Darnell and colleagues, study limitations included the use of catastrophic pain – “a known primary mediator of pain and function [that] is less directly important to most patients and clinicians ”- as the primary outcome. The researchers also pointed out that their findings should encourage the addition of enhanced relief to the chronic lower back pain treatment arsenal.

White, who was not affiliated with the study, said “the results are promising.”

“The scalability potential of this intervention to provide effective, inexpensive, accessible and less burdensome pain treatment is significant,” she said. “However, more research is needed in various patients and other painful conditions.”

The references:

Cherkin DC, et al. Tests. 2014; doi: 10.1186 / 1745-6215-15-211.

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