title: Defining the Role of Cognitive Behavioral Therapy in Treating Chronic Low Back Pain: An Overview.
abstract: Study Design Narrative review of the literature. Objectives Determine if the term cognitive behavioral therapy (CBT) is useful in clinical care and research. What literature supports these variables being relevant to the experience of chronic pain? What effects of CBT in treating these factors have been documented? What methods and platforms are available to administer CBT? Methods Chronic low back pain (CLBP) is a complex neurologic disorder with many components. CBT refers to a broad family of therapies that address both maladaptive thoughts and behaviors. There are several ways to deliver it. CLBP was broken into five categories that affect the perception of pain, and the literature was reviewed to see the effects of CBT on these variables. Results The term cognitive behavioral therapy has little use in future research because it covers such a wide range of therapies. CBT should always be defined by the problem it is intended to solve. The format and method of delivery should be defined because they have implications for outcomes. They are readily available even at the primary care level. The effectiveness of CBT is unquestioned regarding its effectiveness in treating each of the variables that affect CLBP. It is unclear why it is not more widely implemented. Conclusions CBT represents a family of therapies that are effective for a wide range of problems, many of which coexist with and influence CLBP. Each of the variables can be improved with focused CBT. Early, widespread adoption of CBT in treating and preventing CLBP is recommended. Future research and clinical care should focus on strategies to operationalize these well-documented treatments utilizing a public health approach.
authors.affiliation: Swedish Medical Center, Seattle, Washington, United States.
authors.forename: David A
authors.initials: DA
authors.lastname: Hanscom
authors.affiliation: Swedish Medical Center, Seattle, Washington, United States.
authors.forename: Jens Ivar
authors.initials: JI
authors.lastname: Brox
authors.affiliation: Swedish Medical Center, Seattle, Washington, United States.
authors.forename: Ray
authors.initials: R
authors.lastname: Bunnage
keywords: CBT implementation; catastrophizing; chronic pain; cognitive behavioral therapy; expressive writing; insomnia; presurgical screening; structured care