FEATURE STORY / CBT and Chiropractic
CBT was superior to other psychological
treatments for decreasing pain intensity in
fibromyalgia patients.n
In 2011, the European Spine Journal
published the results of a two year follow
up to a study that had examined how a
short, intensive cognitive behavioural pain
management program reduced health care
use in patients with CLBP. Conducted in
the Netherlands, the study intervention
“
on daily functioning and quality of life
were maintained. Patients even reported
experiencing less pain while performing
activities, a result that was statistically
significant.
Moreover, allied health care visits had
decreased considerably and medication
use decreased by 44%. In terms of
quality of life indicators, as compared
to pre-treatment assessment, there was a
A combination of manual and exercise
therapy with CBT-informed patient
education may be exceptionally useful to
chiropractors, particularly when there is
a high likelihood of chronicity expected.
consisted of a total of 100 hours of
participant contact time including 50
hours of cognitive behavioural training,
35 hours of graded physical activity and
15 hours of education into which CBT
principles were integrated. The program
was delivered in a residential setting
over two weeks by teams consisting
of psychologists, physiotherapists and
occupational therapists. The results were
striking.
The study found that long-term
CLBP patients who received a two week
program rooted in cognitive behavioural
principles “learned to manage CLBP pain,
improved fast in daily functioning, and
experienced a fast improvement in their
quality of life.”Q A year later, the same
team revisited the patients to see if the
outcomes were sustained. The researchers
found the 1-year clinically relevant effects
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SPRING 2014
14% increase in the percentage of study
participants working, a 53% reduction in
the number of participants who reported
being unemployed due to their CLBP
and a 46% reduction in the number of
participants collecting disability pensions.Q
Effect size for functioning, as measured
using the Roland & Morris Disability
Questionnaire (RMDQ), was large at 1.6.
Even more striking is that the RMDQ
measurement of 7.5 at 12-months post
treatment remained at 7.2 a year later,
meaning the treatment effects remained
large two years following initial treatment.Q
Another study published in The
Lancet in 2011 examined the benefits
of a stratified approach to care for low
back pain. In this case, three streams
of treatment were created based on the
patient’s risk of chronicity. Risk was
determined using the Keele STarT Back
Screening Tool. The low risk patients
were discharged as further interventions
were believed to be neither beneficial nor
necessary.
The medium risk group received
further care. Patients received up to six
30-minute sessions over a three month
period with a physiotherapist that
incorporated a variety of techniques based
on the specific needs of the patient in
question. These tailored treatment plans
included some of the following elements:
advice and explanation, reassurance,
education, exercise, manual therapy and
acupuncture.
The high risk group received an even
higher level of intervention. Up to six
individualised 45-minute physiotherapy
sessions focussed on restoring function
using combined physical and psychological
approaches and targeting physical and
psychological obstacles to recovery
were provided over a t