Physician-authored summaries and commentary on the most important medical research, provided by the NEJM Group, a division of the Massachusetts Medical Society.
© Massachusetts Medical SocietyJuly 2022
Cognitive behavioural therapy combined with physical therapy was most beneficial for physical function and alleviating fear of movement.
Guidelines for treating patients with chronic, nonspecific low back pain (LBP) recommend both exercise and psychosocial therapies, but the comparative effectiveness of psychological interventions for LBP is unknown. Researchers conducted a network meta-analysis of 97 randomised controlled trials in which different psychological interventions (alone or in combination with other treatments) were compared with nonpsychological interventions (e.g. physical therapy, generalist care, no treatment) in more than 13,000 adults with chronic, nonspecific LBP.
Compared with physical therapy alone, cognitive behavioural therapy (CBT) plus physical therapy was most effective for improving physical function (mean difference, 20 points on a standardised 100 point scale) within two months after treatment (i.e. postintervention), but the effect diminished thereafter. Pain education plus physical therapy had a more modest but more sustained benefit. For reducing postintervention pain intensity, compared with physical therapy alone, behavioural therapy (without a cognitive component) with physical therapy was most effective (mean difference, 27 points), and the benefit was sustained for as long as 12 months. For alleviating postintervention fear of movement, compared with physical therapy alone, CBT plus physical therapy was most effective (mean difference, 47 points), with benefit sustained for more than 12 months.
Comment: These data might help clinicians better tailor psychosocial interventions to individual patients with LBP, based on specific symptoms and goals. The authors note the challenges of delivering often siloed interventions without overly fragmenting care and suggest possible strategies for more effective intradisciplinary versatility and interdisciplinary collaboration.
BRUCE SOLOWAY, MD
Associate Professor of Family Medicine and Attending Family Physician, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York, USA.
Kwan-Yee Ho EK, et al. Psychological interventions for chronic, non-specific low back pain: systematic review with network meta-analysis. BMJ 2022; 376: e067718.
This summary is taken from the following Journal Watch title: Psychiatry.