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By Sarah Klein


FRIDAY, February 26, 2010 (Health.com) — If you have stubborn low back pain, and physical therapy, chiropractic care, or other treatments haven’t helped, there's something else that may be worth trying: group therapy.

Group cognitive behavior therapy (CBT) appears to provide lasting results for nearly 60% of people with back pain that won't go away on its own, according to a study published this week in the Lancet.

"Exactly how it works is hard to say, but it’s about managing your back pain better," says study co-author Zara Hansen, a physiotherapist and cognitive behavioral therapist at the University of Warwick, in Coventry, U.K.

CBT is a type of focused therapy that emphasizes practical solutions and breaking harmful patterns of thinking and acting. Aside from teaching strategies for managing pain (such as getting regular exercise), CBT may reassure people with back pain of their ability to cope, Hansen explains.

The therapy groups "covered a range of different topics designed to target thoughts or beliefs about low back pain,” she says. "For example, identifying and challenging unhelpful thoughts, relaxing, and setting goals for themselves. Essentially, [the therapy] is trying to get across the message that rest is not the way to go, to keep active, and to do things as normally as possible."

Low back pain, one of the most common causes of disability, affects some 34 million people in the United States, according to government data. Americans spend at least $50 billion annually trying to manage, treat, and cure low-back pain, often with no long-term results.

The study looked at about 700 people in the U.K. who had sought treatment for low back pain over the previous six months. After an initial information session on how to manage back pain, roughly two-thirds of the patients were randomly assigned to receive group CBT, while the rest received no further treatment.

The CBT group had 90 minutes of therapy a week for the next six weeks. The sessions were led by a trained psychologist or another qualified health professional, and included about eight patients.

Compared to the control group, the people who received CBT reported less pain during the treatment, and also at three and six months after the therapy began. At one year, 59% of the CBT patients said they were recovered, compared to just 31% in the control group.

It is unusual for back pain treatments to provide relief for 12 months, Hansen says.

Next page: Treatment may be difficult to implement in U.S.


Laxmaiah Manchikanti, MD, a professor of anesthesiology and perioperative medicine at the University of Louisville, in Kentucky, says it's likely that CBT can help back pain. Although "back pain is a complex problem," he says, the study suggests that CBT can "[allow] a person to function" without disability.

However, Dr. Manchikanti points out that the American health-care system may not be amenable to CBT for back pain. Insurers may not cover the treatment, he says, and health-care providers may not have the appropriate training to deliver it. “The U.S. system is not set up for CBT [for back pain]," says Dr. Manchikanti, who wrote an editorial accompanying the study and is also the medical director of the Pain Management Center, in Paducah, Ky.

But in the short term, he adds, primary care physicians might begin to incorporate some CBT methods into their appointments with back pain patients.

In the study, the researchers note that CBT was a very cost-effective treatment for low back pain, at least in the U.K., which has a government-run health-care system. One year of CBT for back pain would cost about $2,700 in the U.K., the researchers estimate. By contrast, a year of physical therapy, acupuncture, or chiropractic care would cost about $5,800, $6,500, and $13,300, respectively.

In the U.K., Hansen says, health professionals will soon be trained to deliver this intervention in the hopes of lessening back pain for a wide range of patients. “We trained existing health professionals in two days and it’s shown success, so we’re not talking about extensive training,” she says. “It’s very practical.”