Back Pain Research Review
Psychological Treatment Methods
Psychological treatment methods are used to complement other treatment and are often included as part of the increasingly common multidimensional pain treatment programs. Cognitive behavioral therapy focuses on managing the problems, feelings, thoughts, and behaviors that pain and functional disabilities may cause.
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Many randomized controlled studies have addressed cognitive behavioral therapy. Although it is difficult to assess the specific impact of cognitive behavioral therapy in multidimensional programs, studies show that programs which include this type of treatment achieve better results than other types of treatment in patients with chronic back problems (A). This particularly applies to treatment effects on anxiety, physical function, and medication use. Influence of Social Factors Social factors which have been reviewed include: the role of culture and family; the influence of unemployment on the consequences of back pain, its intensity, and duration; the role of access to social welfare payments and early pensions; and the importance of relations with work colleagues and the degree of work satisfaction in this context.
Neck and back pain occur in all societies, but cultural groups differ in how they perceive symptoms and react to them. No scientific evidence shows that genetic factors play a role in the occurrence of back pain, except possibly in disc aging. Many studies show that poor social conditions are closely associated with poor general health status, including back pain. Regarding back problems as a risk factor for unemployment and early retirement, several studies clearly show conflicting results without a clear cause-and-effect relationship. Rather, it appears that age, psychological factors, and access to insurance are important explanatory variables in this context.
Several studies show that neck and back pain are not always isolated clinical problems, but are often associated with other pain, other diseases, stress-related symptoms, and work-related or other social problems. Scientific evidence shows, eg, that negative psychosocial aspects in working life, such as poor work satisfaction and poor relationships with others are associated with higher reporting of neck and back problems. There are no confirmed biological mechanisms that can explain how psychosocial factors would cause back pain, nor any evidence of a direct causal relationship.
Role of Primary Care
Many earlier reviews from different countries have led to evidence based guidelines for care of patients with back pain. These have focused on primary care.
The scientific studies currently available show that the interventions provided within primary care are the only ones needed by most patients with back problems. These studies also show that a primary care physician’s most important task is not to intervene unnecessarily. Subjecting a patient to ineffective examinations and treatments carries the risk, eg, that the patient’s back problem can develop into a chronic, life-long disorder.
Conclusions
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