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Exercise and Education Using the CBT Approach for Chronic Low Back Pain

Physical therapists (PTs) around the world have joined the search for a treatment method that can help patients with chronic low back pain (LBP). In this study, therapists from England compare the use of patient education with group therapy using an approach called cognitive behavioral therapy (CBT).

CBT is a way to help patients change how they think about their back pain. It helps them start doing activities they had given up out of fear that it would bring on pain or make their pain worse.

Patients ages 18 to 65 were divided into two groups. Everyone received a booklet of information and a tape to listen to. Both of these tools had advice on stress, posture, and pacing. Setting goals and improving sleep were also included.

One group also received exercise in a group. The sessions were two hours long, once a week, for six weeks. Two PTs lead the group through a series of physical activities and exercises. They taught patients how to identify harmful thoughts. The patients were helped to resume activites or hobbies previously avoided.

Results after treatment were measured based on the basis of the patient's pain and disability. The cost of each treatment was also calculated. The exercise group had only a small improvement over the education group. The patients who had the best results were the ones who specifically asked for this type of group.

The authors offer some ideas why the results were so limited. They suggested that the training the PTs received in CBT wasn't enough to make a difference. Or perhaps because many of the patients only had mild LBP, the effect was minimal. The cost was low so this approach may be worth pursuing.

Future studies must find out if it's the treatment method or the way it's delivered that is the problem. A second area of study should be the influence of belief systems on results. Patients who wanted to be in the exercise group got the best results. Patients who didn't want to be in the exercise group had the worst results.


Ruth E. Johnson, PhD, et al. Active Exercise, Education, and Cognitive Behavioral Therapy for Persistent Disabling Low Back Pain. In Spine. July 1, 2007. Vol. 32. No. 15. Pp. 1578-1585.

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