A recent study published in the Lancet (http://www.thelancet.com/journals/lancet/article/PIIS0140-6736%2809%2962164-4/fulltext) has found that Cognitive Behavioural Therapy (CBT) is of benefit to people with chronic lower back pain, helping to improve the management of pain and maintaining physical activity.

Chronic back pain, particularly of the lower back, is a common disabling condition, significantly affecting quality of life for many people and often affecting performance (and often attendance) at work.

Current best practice for caring for people with persistent non-specific back pain has generally focused on lifestyle modifications, such as encouraging the patient to remain active, or manipulative therapies of some sort, such as physiotherapy.

The study reported in the Lancet was a peer-reviewed, randomised controlled trial (which is the most robust, accurate way of assessing whether a treatment is effective or not), investigating whether treatment was more effective if patients also attended group CBT support sessions.

The trial compared the outcomes from a one-off advice session given by a nurse or physiotherapist with the same advice session combined with CBT group support sessions.  If found that patients given the CBT had improved physical fitness and quality of life, when compared to patients given one-off advice.

The CBT support sessions in the study targeted physical activity and avoidance of activity, including countering negative thoughts about activity, providing advice on different intensity activities and also sharing guidance on relaxation techniques.

Compared with advice alone, the 'advice plus CBT' was associated with significant benefits in disability.  When patients reported how beneficial the treatments had been, 31% of the control group and 59% of the CBT group self-reported recovery at 12 months.

The research suggests that compared to other treatments, such as manipulation, exercise, acupuncture and postural approaches, the benefits of CBT were broader and longer lasting.  It also suggests that when the improvement in quality of life is taken into account, the treatment is cost-effective.

It's worth considering that the approach is only suitable for chronic, 'nonspecific' back pain (pain presenting without an identified medical cause), as there are still serious cases of back pain which need to be excluded before treatment paths are agreed, such as infections, cancer or even tuberculosis.

In summary, the study indicates that CBT may provide a simple and cost-effective way of improving chronic lower back pain.  The study was well conducted and provides good evidence that CBT can be beneficial in helping patients to manage chronic back pain effectively, leading to improvements in quality of life and, hopefully, performance at work.