Evidence statementsEvidence to recommendations

One RCT compared a cognitive behavioural treatment to information/pamphlet and found no significant difference in improvement in pain at 12 months follow-up (1+) (Linton, S. J. and Andersson, T., 2000).

One RCT compared a self care intervention to usual care. The intervention was psychologist-led. Disability was significantly reduced at 3 months, and pain was significantly reduced at 6 months follow-up. No effect was found on mental health (1+) (Moore, James. E., Von Korff, Michael., Cherkin, Daniel. et al, 2000)

No cost effectiveness studies were identified for psychological therapies

A number of randomised controlled trials presented were excluded by the GDG because they were not considered to be psychological interventions, or patients had had other co-interventions or were not compared with usual care.
This decision was reached by consensus.
The GDG agreed that there is evidence in pain management literature that there is benefit from psychological interventions on distress. References to this literature were supplied and the papers reviewed but no studies could be found that showed a significant effect in patients with low back pain as the main presenting condition.
There is limited evidence to support the use of psychological interventions as mono-therapy for non specific low back pain.
One study evaluated a brief intervention which included a 45 minute session with a psychologist which the group agreed should be included. This decision was reached by consensus.
GDG considered that the study had patients who were more severely affected by their pain and therefore a recommendation should be made for this particular group.
No evidence was found for longer treatments of psychological interventions delivered in the absence of concurrent or combined physical therapy. GDG decided by consensus that a recommendation be made for a combined treatment package rather than a standalone psychological intervention.
The group agreed that this was an area where further research was required.

From: 10, Psychological interventions and mixed packages of care (combined physical and psychological interventions)

Cover of Low Back Pain
Low Back Pain: Early Management of Persistent Non-specific Low Back Pain [Internet].
NICE Clinical Guidelines, No. 88.
National Collaborating Centre for Primary Care (UK).
Copyright © 2009, Royal College of General Practitioners.

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