Dr. David B. Adams – Psychological Blog

Psychology of Illness, Pain, Anxiety and Depression

Psychotherapy Rather than Fusion?

chronic painA Norwegian study has shown that patients with chronic lower back pain get as much benefit from behavioural therapy as they do from spinal fusion surgery.

Dr. Jens Ivar Brox, from the National Hospital in Oslo randomly assigned 64 patients to either cognitive behavioural therapy or lumbar fusion and followed their level of disability for the following year. He presented his results at the Annual European Congress of Rheumatology.

The study aimed to rigorously test the surgical technique. Although it is not well understood why the operation only works for some people, it is increasingly popular in some places, he said.

“In California for example, the number of back fusions was 15,000 in 1995 and in 1999 was 21,000. At the same time the price for each operation increased from $35,000 to $46,000.”

All the patients in the study had back pain that had lasted for more than a year, and evidence of disc degeneration. The cognitive therapy involved identifying the patient’s thought and behaviour patterns about their pain, and helping them overcome them, including specific exercises.

“According to an independent observer, the success rate was 70 percent after surgery and 76 percent after cognitive intervention and exercise,” Dr. Brox said. “We had expected that surgery would be better than the non-surgical treatment,” he told reporters at the conference. “But the outcome was similar.”

The measurement of disability was made with the Oswestry Disability Index. The ODI score was reduced from 42 to 30 in the cognitive intervention groups and 41 to 26 in the surgery group.

“This difference between the two groups was not significant,” the researcher said. “However, this study shows clearly that simple cognitive intervention can be both physically- and cost-effective in patients with chronic low back pain.”

He said his group was conducting a followup study, and hoped that other groups would conduct similar research to see if they achieved similar results._

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