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The Effectiveness of a Cognitive-Behavioral and Neurophysiologic-Based Education Intervention in the Treatment of Chronic, Maladaptive Low Back Pain.

1 May 2007


Overall Clinical Bottom Line: From the research reviewed in this Critically Appraised Topic, an education program that instructs in the Neurophysiology of Pain (NPE) or Cognitive-Behavioral Therapy (CBT) has been shown to be an effective treatment for chronic, maladaptive low back pain (cLBP) in an outpatient physical therapy setting. There is quite a bit of literature demonstrating good methodological quality of studies in this area. Of the 10 articles evaluated, seven achieved a "good" rating of at least 9/12 on the methodological scale used. These studies indicate that NPE or CBT combined with physical therapy (PT) are effective for treating cLBP. The research demonstrates improvements in healthcare utilization, sick leave, pain and disability over other treatment methods such as manual therapy, information handouts or minimal medical management. Clinical Scenario: My interest in this topic began with a 32 year-old female with a 10 year history of central low back pain with referral symptoms into the left lower extremity. She was previously diagnosed with a herniated disc at L3-L4 and L4-Ls which was not severe enough to warrant surgery. She has previously undergone physical therapy and chiropractic adjustments which briefly helped the condition about 5 years ago. She is employed as a paralegal which involves significant amounts of time sitting and she has not been able to participate in hobbies that she enjoys secondary to pain and decreased function.


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