Review: behavioural treatment has a small to moderate beneficial effect on chronic low back pain

QUESTION: In patients with chronic non-specific low back pain, is behavioural treatment more effective than other treatments or placebo? Data sources, Studies were identified by searching 3 databases, scanning references of relevant studies and reviews, screening the Cochrane Library, and tracking citations of relevant randomised controlled trials (RCTs) in Science Citation Index., Study selection, Studies were selected if they were RCTs of patients aged 18-65 years of age with non-specific chronic low back pain (symptoms persisting for >/= 12 wks), >/= 1 behavioural treatment was used, and >/= 1 important outcome was assessed. Outcomes were grouped into the following domains: behavioural outcomes, overall improvement, back pain specific functional status, generic functional status, return to work, and self reported pain intensity., Data extraction, 2 reviewers independently assessed the methodological quality of the trials (blinding and withdrawals), and extracted data on outcome domains. Effect sizes (ESs) were calculated for domains within each study for each comparison. ESs were pooled for each domain using a random effects model., Main results, 20 RCTs were included. 5 RCTs had >/= 6 positive quality assessment scores. 11 RCTs compared behavioural treatment with no treatment, waiting list controls, or placebo; 7 RCTs had data that could be pooled. Behavioural treatment had a moderate positive effect on pain intensity and a small positive effect on behavioural outcomes (table). 6 trials that added a behavioural component to such usual treatments as physiotherapy and back education, inpatient pain management, pharmacotherapy, and exercise treatment showed no short or long term effects of behavioural treatment on pain intensity, generic functional status, or behavioural outcomes (table). Differing types of behavioural treatment (cognitive, operant, respondent, and combinations) did not. differ in effectiveness., Conclusion, In patients with chronic non-specific low back pain, behavioural treatment has small to moderate beneficial effects on pain, functional, and behavioural outcomes