Basis, indications and risk

Treatments Basis, indications and risk Patient information Postural hygiene Exercise Maintaining level of Activity Bed rest Pharmacological therapy Neuroreflexotherapy (NRTI) Spinal column surgery Surgery for Pain and Pain Clinics Vertebral manipulation Behavioral treatment Epidural injections Facet joint infections Trigger point and ligament infections Rhizotomy Corsets and lumbar belts Traction Physical therapy/physiotherapy Electromyografic Feedback TENS: Transcutaneous electrical Nerve Stimulation Shoe insoles and shoe lifts Acupunture Recommended treatments

What it is

It is the application of several methods at the same time in order to positively modify the patient's behavior. Although programs may vary from one setting to the other, the more complete ones utilize psychological techniques for behavior modification, give information to the patient and include physical exercise, muscle relaxation techniques and measures to be taken in the family, social, and work settings.

Objective

To modify the attitude and behavior of the back pain patient, promoting confidence in his/her physical ability and encouraging him/her to be as active as possible.

Theoretical base

Many chronic back pain patients develop an attitude towards pain that starts a vicious circle consisting of anxiety and an axegerated fear of pain, excessive rest, lack of physical activity, lack of confidence in their physical ability, and an increase in the risk of having longer and more painful episodes. Finally, that situation can evolve into more back pain, depression, disability, and work disability.

Behavioral treatment improves back pain and prevents these psychological and social consequences. Its goal is to improve the patient's attitude and behavior with regard to pain, encouraging him/her to be as active as possible and face the pain in a more positive manner.

There are different programs with different techniques to achieve this goal. The more complete ones are very intensive: 8 hours daily during 4 weeks. They include 3 hours of daily exercise and physical activity, individual goal setting for each patient, problem solving, relaxation therapy, health education, and contact with the family, social and work environments of the patient. In this manner, all the information and incentives received will stimulate the patient to increase his/her activity and to minimize the limitations caused by the pain. These programs include the participation of physicians, physical therapists, nurses, and psychologists.

Scientific evidence of their effectiveness

Scientific studies demonstrate that multimodal behavioral treatment is more effective than not doing anything in chronic patients. It lessens the intensity of pain and increases the degree of activity, but does not reduce work absenteeism.

Risks and contraindications

None, other than its cost and complexity, which may limit access for some.

A recent systematic rewiew found behavioral treatment to be effective for improving pain and disability, with no evidence of any type of behavioral therapy being more effective than any other.

Indications

Behavioral treatment is not mentioned in the existing recommendations based on scientific evidence, since the majority of studies to evaluate its effectiveness were done after the appearance of these guidelines, and these refer especially to acute patients, whereas this therapy mainly focuses on chronic cases.

Behavioral treatment is indicated for chronic back pain patients, as well as for those patients with psychosocial factors putting them at a higher risk of becoming chronic.