Cognitive-behavioral therapy for chronic low back pain in older persons: a preliminary study

To determine the feasibility and potential efficacy of providing cognitive-behavioral therapy (CBT) to older persons with chronic low back pain (CLBP).

This was an uncontrolled pilot study conducted at a senior housing center (SHC) in New Haven, Connecticut. Fourteen SHC residents aged 65 years and older who were cognitively intact (Mini Mental State Examination score > or =24) and had CLBP were recruited for the study. CBT was administered in 10 weekly individual sessions. Participants were phoned 5 days on average after each session (range: 3-7 days) to determine their comprehension and perceived usefulness of the CBT materials and adherence with the assigned homework exercises. Using standardized measures, we determined participants' levels of pain intensity, pain-related disability, and physical and social activity at baseline, and at 2 and 24 weeks posttreatment.

Participants had a mean age of 77.4 (+/-7.9 SD) years and were mostly female (86%). Thirteen (93%) participants completed all 10 sessions. Comprehension of CBT, defined as self-reported understanding of the materials presented each week, exceeded 97%. The perceived usefulness of each treatment session was assessed on a 0-10 scale, and the mean ratings for the sessions ranged from 7.5-9.4. The mean number of days that participants practiced the homework exercises each week varied from 1.8 to 4.0. Significant reductions (P < 0.01) in participants' pain intensity and pain-related disability scores were found at the 2-week posttreatment (vs pretreatment) assessment. These treatment effects waned over time, but did not return to pretreatment levels at 24 weeks. Participants' physical and social activity levels did not change.

CBT is a feasible treatment for cognitively intact, older persons with CLBP, and may be efficacious as well.