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Behavioural treatment for chronic low-back pain
R W J G Ostelo1, M W van Tulder, J W S Vlaeyen
1Institute for Research in Extramural Medicine, VU University Medical Center, van der Boechorststraat 7, Amsterdam, Netherlands, 1081 BT. r.ostelo.emgo@med.vu.nl
The Cochrane Database of Systematic Reviews
|January 28, 2005
Summary
Behavioral therapy, including respondent-cognitive and progressive relaxation, offers short-term pain relief for chronic low-back pain (CLBP) compared to waiting lists. However, long-term effectiveness and superiority over exercise therapy remain uncertain.
Area of Science:
- Rehabilitation Medicine
- Behavioral Psychology
- Pain Management
Background:
- Behavioral treatment is a common approach for chronic low-back pain (CLBP), aiming to reduce disability by modifying environmental factors and cognitive processes.
- Key behavioral treatment approaches include operant, cognitive, and respondent therapies.
Purpose of the Study:
- To evaluate the effectiveness of behavioral therapy compared to reference treatments for CLBP.
- To identify which specific types of behavioral treatment are most effective for CLBP.
Main Methods:
- Systematic review of randomized trials identified through searches of CENTRAL, MEDLINE, EMBASE, and PsycLIT databases up to October 2003.
- Inclusion criteria: randomized trials on behavioral treatment for non-specific CLBP.
- Data extraction and quality assessment by two independent reviewers; pooled effect sizes calculated using random effects models for various outcomes.
Main Results:
- Combined respondent-cognitive therapy and progressive relaxation showed significant short-term benefits for pain relief compared to waiting list control (WLC).
- Operant treatment did not show significant differences from WLC for functional status or behavioral outcomes in the short term.
- Limited evidence suggests graded activity programs may improve return to work and reduce sick leave; no significant differences were found between behavioral treatment and exercise therapy.
Conclusions:
- Respondent-cognitive therapy and progressive relaxation are effective for short-term pain relief in CLBP patients compared to WLC.
- Long-term efficacy of these behavioral therapies is uncertain.
- No significant differences in effectiveness were observed between behavioral treatment and exercise therapy for CLBP.