[A psychological therapy methods in chronic non-radicular backache]

The presence of psychological co-morbidity and difficulties in coping with chronic low-back pain are indications for the application of psychological therapy procedures. In the treatment of patients with chronic pain, the aim of therapy as well as the technique of the traditionally employed psychotherapeutic procedures need to be modified. What is of immediate importance is to promote an active pattern of coping with pain and discourage pain-related inactivity and reduce feelings of helplessness and hopelessness. To achieve this, it is necessary to combine various psychological treatment modalities (relaxation techniques and behavioural or psychodynamic therapy) with exercise programs as in physiotherapy or sports medicine. In the choice of the appropriate psychotherapeutic modalities, it is important to take into consideration the extent of chronicity of pain, the patient's subjective understanding of the illness, a possible wish of the patient for early retirement, previous experience with chronic pain and the extent to which the patient has been psychologically traumatised (especially in his childhood and youth). Relatives should be integrated in the planning and possibly also in carrying out of the treatment. Symptom-specific group therapy might motivate patients to undergo treatment and to change their habitual ways of life. A multimodal treatment approach incorporating orthopaedic, sports medicine, physiotherapeutic, psychological and socio-therapeutic procedures have proved to be more effective in the treatment of chronic pain than one employing monocausal treatment modalities.