Cognitive Behavioral Therapy (CBT) for Subacute Low Back Pain: a Systematic Review
Purpose of Review
Chronic low back pain (CLBP) is a major source of physical and psychiatric morbidity and mortality, and the current overreliance on opioid analgesics has contributed to a burgeoning epidemic in the USA. Cognitive behavioral therapy (CBT) is an empirically supported treatment for CLBP, but little information exists regarding its potential efficacy for CLBP’s precursor condition, subacute low back pain (sALBP), defined here as having a 7–12-week duration. Earlier intervention with CBT at the sALBP stage could produce larger clinical benefits. This systematic review was undertaken to characterize and highlight this knowledge gap.
Of 240 unique articles identified by comprehensive database searches, only six prospective, sALBP-focused, randomized controlled trials (RCTs) published within the past 20 years met criteria for inclusion in this review. These studies varied widely in their sample sizes, precise definition of sALBP, nature of CBT intervention, and outcome measures. Five of the six showed significant improvements associated with CBT, but the heterogeneity of the studies prevented quantitative comparisons.
CBT has not been adequately studied as a potential early intervention treatment for sALBP patients. None of the six identified papers studied US civilians or leveraged innovations such as teletherapy—able to reach patients in remote or underserved areas—underscoring critical gaps in current back pain treatment. Given the severity of the US opioid epidemic, non-pharmacologic options such as CBT should be rigorously explored in the sALBP population.
KeywordsSubacute Back pain Cognitive behavioral therapy CBT Systematic review Outcome Treatment
The authors thank Anne Fladger, Dalton Tuggle, and Limeng Wan for their assistance.
TYM was partially supported by a 2015 NARSAD Young Investigator Grant and a 2017 Harvard Medical School Norman E. Zinberg Fellowship in Addiction Psychiatry Research.
Compliance with Ethical Standards
Conflict of Interest
Richard D. Urman, Catherine A. Hutchison, Robert N. Jamison, and Robert R. Edwards declare no conflict of interest. Dr. Mariano was on an advisory board of Janssen Pharmaceuticals for treatment-resistant depression in 12/2016, both outside of this work.
Human and Animal Rights and Informed Consent
This article does not contain any studies with human or animal subjects performed by any of the authors.
Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance
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