For people with chronic, nonspecific low back pain, psychological interventions are most effective when delivered in conjunction with physical therapy care (mainly structured exercise), according to a review published online March 30 in The BMJ.
Emma Kwan-Yee Ho, from University of Sydney, and colleagues conducted a systematic literature review to identify randomized controlled trials comparing psychological interventions to any comparison intervention in adults with chronic (>12 weeks) nonspecific low back pain.
In a network meta-analysis of data from 97 randomized controlled trials (13,136 participants and 17 treatment nodes), the researchers found that for physical function, cognitive behavioral therapy (standardized mean difference [SMD], 1.01; 95 percent confidence interval [CI], 0.58 to 1.44) and pain education (SMD, 0.62; 95 percent CI, 0.08 to 1.17), delivered with physical therapy care, resulted in clinically important improvements at postintervention (moderate-quality evidence). For pain intensity, there were clinically important effects noted at postintervention (low- to moderate-quality evidence) for behavioral therapy (SMD, 1.08; 95 percent CI, 0.22 to 1.94), cognitive behavioral therapy (SMD, 0.92; 95 percent CI, 0.43 to 1.42), and pain education (0.91; 95 percent CI, 0.37 to 1.45), delivered with physical therapy care. Only behavioral therapy plus physical therapy care maintained clinically important reductions in pain intensity until midterm follow-up (SMD, 1.01; 95 percent CI, 0.41 to 1.60; high-quality evidence).
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