The pathway to successful treatment of chronic back pain lies partly through your head, according to a new German study.
The use of positive thinking therapy, combined with personal coaching, is the most effective form of treatment, a research team at Goethe University in Frankfurt, Germany finds.Read More »
Forget the use of ineffective forms of surgery and X-rays, which are often used in the United States largely to make large amounts of money, says the lead author of the study, Dr. Johannes Fleckenstein of the Institute of Sport Sciences at Goethe University Frankfurt. Indeed, he adds, X-rays also can contribute to the chronic nature of pain.
In addition, too many prescriptions are written for strong narcotics, such as opiates, he adds.
The research suggests there are far better ways to handle chronic back pain.
Symptoms continue without stopping
The researchers point out that back pain can be caused by bad posture, a lack of exercise, overexertion, or constant stress at home or at work.
In many cases, they add, the symptoms are chronic; they recur over and over again or continue unabated for a long time.
Relief from such back pain can be achieved through exercise and sport. Regular methods of treatment that include stability and strength exercises as well as physiotherapy are also helpful.
The question arises, however, as to how to make the therapy as successful as possible.
Data from people around the world
In order to find answers, the research team at Goethe University Frankfurt, studied information from 10,000 people around the world who suffer from chronic low back pain.
They started by examining the results of standard forms of treatment compared with individualized treatment. Such individualized treatment involved some sort of personal coaching in which therapists direct their treatment at the requirements and potential of each patient. They then discuss with the patient how the therapy should be conducted.
The study found that individualized treatment for chronic back pain was three times more effective than standard exercise therapies.
The greater effort that is required for individual treatment is worth taking because patients benefit to a degree that is important clinically, says lead author Fleckenstein.
Third form of treatment
The researchers compared a third form of treatment that combined cognitive behavioral therapy (CBT) with personal coaching. This treatment consisted of a kind of “talk therapy” or positive thinking that is based on the belief that negative thoughts and actions involving pain tend to make it worse.
Through the use of CBT patients learn to alter the way they handle their pain. They stop being afraid to move. They also are taught ways in which they can cope with the pain.
The result is that the patients start to realize that they are not helpless in any way against the pain.
Does this psychotherapy help to make treatment more successful?
When the research team combined the effects of the individualized treatment with that of CBT the success rate was an impressive 84% higher than the success rate with standard forms of treatment.
The best results, therefore, came with what the research team calls “multimodal therapy.”
Treatments should be promoted
Fleckenstein urges those involved in public health policy to promote therapies that combine these treatments. They should do so, he adds, in terms of both costs and patient care.
Compared with other countries, such as the United States, German medical professionals are in a relatively good position, he explains.
For example, fewer prescriptions are issued for strong narcotic drugs, such as opiates.
More important, however, is that the number of inaccurate surgical indications is extremely high in the United States. In addition, the use of a large number of X-rays—which can add to the chronic nature of pain—is too high.
Fleckenstein attributes these factors to the high costs for surgery and X-rays. The incentive for medical practices to use these treatments, therefore, is high. Put simply: They bring in large amounts of money and are generally unnecessary.
Therapy saves a lot of money over time when it comes to health economies, Fleckenstein adds. Medication and surgery, however, rarely lead to medium and long-term pain relief.