Table 6Chronic low back pain: psychological therapies

Author, Year, Followup, Pain Duration, Study QualityInterventionPopulationFunction and Pain OutcomesOther Outcomes

Cherkin, 2016

Herman, 2017

Cherkin, 2017 (2 year data from Cherkin, 2016)

22 months

Duration of pain: >3 months (>1 year in 80% of patients)

Fair

A. (n=112), 8 sessions over 8 weeks

B. Usual care (n=113)

A vs. B

49 vs. 49 years

Female: 59% vs. 77%

Baseline modified (0-23): 11.5 vs. 10.9

Baseline pain bothersome-ness (0-10): 6.0 vs. 6.0

A vs. B

4.5 months

Modified (0-23): −4.38 (95% −5.3 to −3.47) vs. −2.96 (95% CI −3.79 to −2.14)

Pain (0-10): −1.56 (95% −2.02 to −1.11) vs. −0.84 (95% CI −1.21 to −0.46)

10 months

Modified (0-23): −4.78 (95% −5.67 to −3.89) vs. −3.43 (95% CI −4.33 to −2.52)

Pain (0-10): −1.76 (95% −2.14, −1.39) vs. −1.10 (95% CI −1.48, −0.71)

≥30% improvement in pain: 39.6% (95% 31.7 to 49.5) vs. 31.0% (95% CI 23.8 to 40.3)

≥30% improvement in modified : 58.8% (95% 50.6 to 68.4) vs. 48.6% (95% CI 40.3 to 58.6)

22 months

Modified (0-23): −4.59 (95% −5.60 to −3.57) vs. −2.74 (95% CI−3.81 to −1.68)

≥30% improvement in modified : 62.0% (95% 53.5 to 71.7) vs. 42.0% (95% CI 33.8 to 52.2)

Pain: −1.79 (95% −2.21 to −1.37) vs. −1.25 (95% CI −1.69 to −0.81)

≥30% improvement in pain: 39.6% (95% 31.4 to 49.8) vs. 31.1% (95% CI 23.9 to 40.5)

A vs. B

4.5 months

(0–24): −1.80 (95% −2.35 to −1.26) vs. −0.64 (95% CI −1.23 to −0.06)

SF-12 Physical component (0-100): 3.78 (95% 2.56to 5.00) vs. 3.27 (95% CI 2.09 to 4.44)

SF-12 Mental component (0-100): 2.13 (95% 0.86 to 3.40) vs. −1.11 (95% CI −2.39 to 0.17)

10 months

(0–24): 1.72 (95% −2.28 to −1.16) vs. −0.88 (95% CI −1.50 to −0.27)

SF-12 Physical component: 3.79 (95% 2.55 to 5.03) vs. 2.93 (95% CI 1.70 to 4.16)

SF-12 Mental component: 1.81 (95% 0.59 to 3.03) vs. 0.75 (95% CI −0.58 to 2.08)

Total costs: $6,428 (95% $4676 to $10,262) vs. $6,304 (95% CI $4,193, $9,805)

Johnson, 2007

12 months

Duration of pain: 6 months

Fair

A. (n=116), 8 sessions over 6 weeks

B. Usual care (n=118)

A vs. B

Age: 47 vs. 49

Female: 61% vs. 58%

Baseline (0-24): 10.6 vs. 10.9

Baseline pain (0-100 ): 44.9 vs. 51.6

A vs. B

6 months

(0-24): 6.5 vs. 8.0, adjusted difference −1.09 (95% −2.28 to 0.09)

Pain (0-100 ): 26.1 vs. 35.0, adjusted difference −4.60 (95% −11.07 to 1.88)

12 months

(0-24): 6.7 vs. 8.0, adjusted difference −0.93 (95% −2.30 to 0.45)

Pain (0-100 ): 27.9 vs. 36.4, adjusted difference −5.49 (95% −12.43 to 1.44)

A vs. B

6 months

Quality of life (0-1 ): 0.75 vs. 0.71, adjusted difference 0.03 (95% −0.05 to 0.10)

12 months

Quality of life (0-1 ): 0.75 vs. 0.71, adjusted difference 0.03 (95% −0.04 to 0.09)

Lamb 2010 and 2012

34 months

Duration of pain: 13 years

Fair

A. (n=468), 8 sessions over unclear number of weeks

B. Attention control (n=233)

A vs. B

Age: 53 vs. 54 years

Female: 59% vs. 61%

Korff disability (0-100): 49 vs. 46

Baseline (0-24): 9 vs. 9

Baseline pain (0-100 Modified Von Korff): 59 vs. 59

Modified Von

A vs. B

3 months

Modified Von Korff disability (0-100): −13.2 (−15.74 to −10.59) vs. −8.9 (−12.27 to −5.56), adjusted difference −4.2 (−8.10 to −0.40)

(0-24): −2.0 (−2.43 to −1.58) vs. −1.1 (−1.54 to −0.35) adjusted difference −1.1 (−1.71 to −0.38)

Modified Von Korff pain (0-100): −12.2 (−14.56 to −9.83) vs. −5.4 (−8.40 to −2.49), adjusted difference −6.8 (−10.20 to −3.31)

4.5 months

Modified Von Korff disability: −13.9 ( −16.25 to −11.55) vs. −5.7 (−9.22 to −2.28), adjusted difference −8.2 (−12.01 to −4.31)

: −2.5 (−3.03 to −1.96) vs. −1.0 ( −1.67 to −0.40), adjusted difference −1.5 (−2.22 to −0.70)

Modified Von Korff pain: −13.7 (−16.20 to −11.29) vs. −5.7 (−8.99 to −2.41), adjusted difference −8.0 (−11.80 to −4.28)

10.5 months

Modified Von Korff disability: −13.8 (−16.28 to −11.39) vs. −5.4 (−8.90 to −1.99), adjusted difference −8.4 (−12.32 to −4.47)

: −2.4 (−2.84 to −1.89) vs. −1.1 (−1.72 to −0.39), adjusted difference −1.3 (−2.06 to −0.56)

Modified Von Korff pain: −13.4 (−15.96 to −10.77) vs. −6.4 (−9.66 to −3.14), adjusted difference −7.0 (−10.81 to −3.12)

34 months

Modified Von Korff disability: −16.7 (−19.43 to −13.93) vs. −11.2 (−15.59 vs. −6.86), adjusted difference −5.5 (−10.64 to −0.27)

: −2.9 (−3.42 to −2.38) vs. −1.6 (−2.48 to −0.80), adjusted difference −1.3 (−2.26 to −0.27

Modified Von Korff pain: −17.4 (−20.35 to −14.44) vs. −12.8 (−17.52 to −7.99), adjusted difference −4.6 (−10.28 to 1.00)

A vs. B

3 months

SF-12 PCS (0-100): 3.7 (2.82 to 4.59) vs. 1.5 (0.26 to 2.83), adjusted difference 2.2 (0.74 to 3.57)

SF-12 MCS (0-100): 1.3 (0.19 to 2.42) vs. 0 (−1.45 to 1.46), adjusted difference 1.3 (−0.36 to 2.96)

4.5 months

SF-12 PCS: 3.6 (2.72 to 4.52) vs. 1.8 (0.54 to 3.08), adjusted difference 1.8 (0.37 to 3.25)

SF-12 MCS: 2.5 (1.44 to 3.48) vs. −0.09 (−1.61 to 1.43), adjusted difference 2.6 (0.85 to 4.25)

10.5 months

SF-12 PCS: 4.9 (4.00 to 5.84) vs. 0.8 (−0.52 to 2.11), adjusted difference 4.1 (2.63 to 5.62)

SF-12 MSC: 0.9 (−0.10 to 1.90) vs. 0.7 (−0.75 to 2.20), adjusted difference 0.2 (−1.48 to 1.84)

34 months

: 0.07 (0.04 to 0.10) vs. 0.04 (−0.01 to 0.09), adjusted difference 0.03 (−0.03 to 0.08)

Poole, 2007

4.5 months

Duration of pain: 10.6 vs. 9.5 years

Poor

A. Respondent therapy (progressive muscle relaxation) (n=54), 6 sessions over 6-8 weeks

B. Usual care (n=45)

A vs. B

Age: 46 vs. 47

Female: 65% vs. 51%

Baseline Oswestry Disability Index (0-100% ): 33.2 vs. 36.6

Baseline pain (0-100 ): 40.7 vs. 40.6

A vs. B

4.5 month

(0-100): 31.3 vs. 32.9

Pain (0-100 ): 41.3 vs. 42.7

A vs. B

4.5 month

Beck Depression Inventory (0-63): 12.6 vs. 12.8

SF-36 physical functioning (0-100): 57.3 vs. 52.2

SF-36 social functioning (0-100): 66.7 vs. 61.5

SF-36 emotional role limitations (0-100): 63.0 vs. 62.0

SF-36 pain (0-100): 48.8 vs. 44.4

SF-36 mental health (0-100): 64.4 vs. 67.7

SF-36 general health perception (0-100): 52.4 vs. 55.0

Turner, 1990

12 months

Duration of pain: 12.9 years

Poor

A. Operant therapy (n=25), 8 sessions over 8 weeks

B. Exercise (n=24)

Overall

Age: 44

Female: 48%

A vs. B

Baseline function (0-100 ): 7.9 vs. 8.4

Baseline pain (0-78 McGill Pain Rating): 21.0 vs. 19.4

A vs. B

6 months

Sickness Impact Profile (0-100): 7.6 vs. 6.3

McGill Pain Questionnaire Pain Rating Index (0-78): 19.5 vs. 15.7

12 months

Sickness Impact Profile (0-100): 5.3 vs. 4.7

McGill Pain Questionnaire Pain Rating Index: 16.4 vs. 14.9

A vs. B

6 months

Scale (0-60): 11.4 vs. 9.3

12 months

Scale: 8.3 vs. 9.3

= cognitive-behavioral therapy; = Center for Epidemiologic Studies-Depression; = confidence interval; MCS = Mental Component Score; = Oswestry Disability Index; PCS = Physical Component Score; = Patient Health Questionnaire 8-item depression scale; = Roland-Morris Disability Questionnaire; SF-12 = Short-Form 12 Questionaire; SF-36, Short-Form 36 Questionnaire; = Sickness Impact Profile; = visual analog scale

a

Unless otherwise noted, followup time is calculated from the end of the treatment period

From: Results

Cover of Noninvasive Nonpharmacological Treatment for Chronic Pain: A Systematic Review Update
Noninvasive Nonpharmacological Treatment for Chronic Pain: A Systematic Review Update [Internet].
Comparative Effectiveness Review, No. 227.
Skelly AC, Chou R, Dettori JR, et al.

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