Group CBT for low-back pain in primary care appears beneficial

January 01, 0001

Group CBT for low-back pain in primary care appears beneficial

Low-back pain is a common and costly problem. The researchers from the UK estimated the effectiveness of a group cognitive behavioural intervention in addition to best practice advice in people with low-back pain in primary care. In this pragmatic, multicentre, randomised controlled trial with parallel cost-effectiveness analysis undertaken in England, 701 adults with troublesome subacute or chronic low-back pain were recruited from 56 general practices and received an active management advisory consultation. Participants were randomly assigned by computer-generated block randomisation to receive an additional assessment and up to six sessions of a group cognitive behavioural intervention (n=468) or no further intervention (control; n=233).

At 12 months, mean change from baseline in the questionnaire score was 1.1 points in the control group and 2.4 points in the cognitive behavioural intervention group (difference between groups 1.3 points, significant). The modified Von Korff disability score changed by 5.4% and 13.8%, respectively (difference between groups 8.4%, significant). The modified Von Korff pain score changed by 6.4% and 13.4%, respectively (difference between groups 7.0%, significant). The additional quality-adjusted life-year (QALY) gained from cognitive behavioural intervention was 0.099; the incremental cost per QALY was £1786, and the probability of cost-effectiveness was greater than 90% at a threshold of £3000 per QALY. There were no serious adverse events attributable to either treatment.

The researchers concluded: "Over 1 year, the cognitive behavioural intervention had a sustained effect on troublesome subacute and chronic low-back pain at a low cost to the health-care provider."

Many patients do like extra attention, so it is unclear if the benefit may be associated with the group sessions or their CBT content.

For the full abstract, click here.

The Lancet published online 26 February 2010
© 2010 Elsevier Limited
Group cognitive behavioural treatment for low-back pain in primary care: a randomised controlled trial and cost-effectiveness analysis. Sarah E Lamb, Zara Hansen, Ranjit Lall et al on behalf of the Back Skills Training Trial investigators. Correspondence to Sarah Lamb: [email protected]

Category: M. Musculoskeletal, P. Psychological, HSR. Health Services Research. Keywords: group, cognitive behavioural therapy, low back pain, primary care, randomised controlled trial, cost-effectiveness analysis, journal watch.
Synopsis edited by Dr Stephen Wilkinson, Melbourne, Australia. Posted on Global Family Doctor 19 March 2010

Pearls are an independent product of the Cochrane primary care group and are meant for educational use and not to guide clinical care.