Psychological treatments improve outcomes for back pain sufferers
- From: William Wagner <not-to-here-williamwag@xxxxxxxxx>
- Date: Fri, 22 Dec 2006 06:24:32 -0500
"The paradox is that, despite data on the effectiveness of
psychological interventions, insurers are less willing to pay for them."
........................................
http://www.eurekalert.org/
Public release date: 22-Dec-2006
Contact: Lisa Esposito
press@xxxxxxxx
Center for the Advancement of Health
Psychological treatments improve outcomes for back pain sufferers
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.
"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."
###
By Kelly Griffin, Contributing Writer Health Behavior News Service
FOR MORE INFORMATION Health Behavior News Service: Lisa Esposito, editor
at (202) 387-2829 or www.hbns.org
"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@xxxxxxxxxxxx) and
Timothy Smith (tim.smith@xxxxxxxxxxxxxx).
Hoffman BM, et al. Meta-analysis of psychological interventions for
chronic low back pain. Health Psychology 26 (1), 2007.
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