One pain class noninferior to cognitive behavioral therapy for lower back pain
A single 2-hour pain management class provided as much pain catastrophizing benefit as eight 2-hour sessions of cognitive behavioral therapy in adults with chronic low back pain, according to results of a randomized clinical trial.
“CBT delivered in groups can offer important elements like contact with a therapist and peer support,” Helene Langevin, MD, director of the NIH’s National Center for Complementary and Integrative Health (NCCIH), said in a press release. “But we realize that 16 hours of treatment time and the associated costs could be out of reach for some patients.”
Della White, PhD, the program director of extramural research at the NCCIH, told Healio Primary Care that “efficient, low-cost treatments” for pain catastrophizing are needed to alleviate patient burden and expand access to treatment.
For the study, Beth D. Darnall, PhD, a professor in the department of anesthesiology, perioperative and pain medicine at the Stanford University School of Medicine, and colleagues randomly assigned 263 adults with a pain score of at least 4 on the 10-point Numeric Pain Rating Scale and a moderate Pain Catastrophizing Scale score of at least 20 to one of the following interventions:
- A single 2-hour “empowered relief” class that provided information on pain neuroscience, the concept of mindfulness and CBT. The class was designed to help participants recognize “distressing thoughts and emotions, cognitive reframing, relaxation response exercise and a self-soothing action plan,” the researchers wrote.
- A health education class that mirrored the empowered relief intervention regarding length, structure, format and location, and also provided an overview of warning signs of back pain and when to consult a physician, general nutrition and medication.
- Eight 2-hour CBT sessions that, according to a previous study, taught participants about “maladaptive automatic thoughts,” managing their own pain, “activity pacing and scheduling, relapse prevention and maintenance of gains.”
About half of the study participants were women, more than 60% were white and the mean age was 47.9 years. The participants’ progress was measured after 3 months.
The researchers reported that the empowered relief intervention was noninferior to CBT for pain catastrophizing (difference from CBT = 1.39 [97.5% CI, to 4.24]). Both empowered relief and CBT were superior to the health education intervention (empowered relief difference from health education = –5.9 [95% CI, –8.78 to –3.01]; CBT difference from health education = –7.29 [95% CI, –10.2 to –4.38]).
In addition, drops in pain catastrophizing scores among the empowered relief and CBT cohorts were “clinically meaningful” (empowered relief = –9.12 [95% CI, –11.6 to –6.67]; CBT = –10.94 [95% CI, –13.6 to –8.32] and health education = –4.6 [95% CI, –7.18 to 2.01]), according to the researchers. Although empowered relief was inferior to CBT for physical function, the two interventions yielded similar benefits for factors such as pain intensity, pain interference, sleep disruptions depression and anxiety.
According to Darnell and colleagues, study limitations included the use of pain catastrophizing — “a known primary mediator of pain and function [that] is less directly important for most patients and clinicians” — as the primary outcome. The researchers also emphasized that their findings should encourage adding empowered relief to the chronic lower back pain treatment armamentarium.
White, who was not affiliated with the study, said “the findings are promising.”
“The potential for scalability of this intervention to provide effective, low-cost, accessible and less burdensome treatment for pain is notable,” she said. “However, additional research is needed in diverse patients and other pain conditions.”