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Senior Citizen Health & Medicine
Psychological Treatment Reduces Intensity of Lower
Back Pain: 10-Year Study
Editor's Note: "Living with pain" is almost synonymous
with "senior citizen." At least part of the reason so many older people
suffer from unrelenting pain is that we are living longer and enduring
more of the suffering that comes from aging bodies. This report looks at
10 years of research on using psychological treatments for relief.
By
Kelly Griffin
 December 22, 2006 - Psychological interventions for
chronic low back pain are effective, a new review of studies has found.
Not only do these approaches improve psychological outcomes such as
depression and health-related quality of life, they also reduce
patients' experience of pain.
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"Because this analysis was both more inclusive and
more conservative than previous reviews, we have the best evidence to
date that these interventions are helpful," said psychologist and review
lead author Robert Kerns, Ph.D., of the VA Connecticut Healthcare
System.
The review, part of a new article series, appears
in the January issue of the journal Health Psychology. Each
evidence-based review centers on a specific psychological assessment or
treatment conducted in the context of a physical disease process or risk
reduction effort.
To evaluate the effects of psychological
interventions on pain-related outcomes, Kerns and his team gathered data
from 22 randomized trials published between 1982 and 2003. Trials were
limited to adults with nonmalignant low back pain that had persisted for
at least three months. However, most patients had been living with pain
for much longer. The average duration was seven and a half years.
The studies were not limited to any one
psychological approach. Included in the review were behavioral and
cognitive-behavioral techniques; self-regulatory techniques such as
hypnosis, biofeedback, and relaxation; and supportive counseling.
The review reports on 12 pain-related outcomes,
including pain intensity, pain interference, depression, health care
use, disability and health-related quality of life.
In the broadest analysis, psychological
interventions - alone or as part of a multidisciplinary approach -
proved to be superior to waiting lists or standard treatments on the
entire range of pain-related outcomes.
When the researchers analyzed specific outcomes,
they found that the largest and most consistent effect was a reduction
in pain intensity.
This was somewhat surprising, Kerns said, because
when psychologists first began developing interventions for chronic pain
several decades ago, the goal was not to reduce pain but to help
patients live with their pain more successfully.
"However, a growing body of knowledge suggests that
these interventions are actually having a primary effect on people's
experience of pain," he said.
The review found that psychological interventions
also yielded improvements in health-related quality of life,
work-related disability, interference of pain with daily living and
depression.
Not all treatments were equally effective.
Cognitive-behavioral and self-regulatory treatments seemed to yield the
greatest effects, particularly when compared to waiting list control
groups. Multidisciplinary approaches that included a psychological
component also stood out on some measures, reducing pain interference
and work-related disability when compared to other active treatments.
According to Dennis Turk, Ph.D., a professor of
anesthesiology and pain research at the University of Washington in
Seattle, patients with chronic pain sometimes fail to recognize the
value of psychological treatments because they've been set up to expect
a cure.
"Even the latest and greatest treatments don't cure
people with chronic pain," he said. "Psychological interventions are not
cures, but they do reduce pain and improve function and they are
important components in the treatment of people with chronic pain."
Turk added that psychological interventions are
also cost-effective when compared to other treatments for chronic low
back pain -- a key finding, considering that estimates for
treatment-related costs range from $20 billion to $80 billion a year in
the United States.
"Surgery, opioids, nerve blocks, spinal cord
stimulators, implantable drug delivery systems -- every one of those
particular alternatives is much more expensive and has poorer or at best
equal outcomes compared to rehabilitation programs that include
psychological components," said Turk. "The paradox is that, despite data
on the effectiveness of psychological interventions, insurers are less
willing to pay for them."
Getting the word out that these treatments are
effective and cost-effective is a challenge that psychologists will have
to tackle head-on, Kerns said.
"We need to specifically target health care system
administrators and third-party payers to try to engage them in a more
productive dialogue about the importance of these interventions," he
said. "We continue to have a huge, very costly problem in our society,
but we have an intervention that is effective, and we need to do a
better job of creating access to these services."
Editor's Notes:
Kelly Griffin is a Contributing Writer for Health
Behavior News Service
"Evidence-based Treatment Reviews" is a new
series initiated within Health Psychology, an official journal of the
American Psychological Association. This series of articles is intended
to inform health psychology practice, add to teaching and mentoring
resources, and inspire further evidence-based research and questions.
For more information, contact editors Karina Davidson (kd2124@columbia.edu)
and Timothy Smith (tim.smith@psych.utah.edu).
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