Graded In Vivo Exposure Elements May Benefit Chronic Lower Back Pain Management

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The study included matched pairs of participants with chronic low back pain for >6 months and elevated pain-related fear.
The study included matched pairs of participants with chronic low back pain for >6 months and elevated pain-related fear.

Integrating graded in vivo exposure into the management of chronic lower back pain may result in improved treatment efficacy and reduced pain-related fear, according to study results published in Behaviour Research and Therapy.

The study included matched pairs of participants with chronic low back pain for >6 months and elevated pain-related fear. Participants were randomly assigned to receive graded in vivo exposure consisting of psycho-educational and exposure elements, or cognitive-behavioral therapy (CBT) in a yoked design. The investigators assessed pain symptoms, disability, pain-related fear, acceptance, body confidence, self-efficacy, and positive thoughts at baseline during treatment and at 6-month follow-up.

Participants receiving graded in vivo exposure were found to have significant changes in pain perception (standardized mean difference [SMD],−0.50), perceived harmfulness of personally-relevant activities (SMD, −0.40), self-efficacy (SMD, 1.07), pain acceptance (SMD, 1.16), and body confidence (SMD, 1.18) during the exposure — not the psycho-educational — elements ( P ≤.05 for all). At the 6-month follow-up, only changes in self-reported exposure remained significant (SMD, 0.93; P ≤.05).

In participants in the CBT group, no changes were recorded during therapy. CBT was found to result in delayed small to medium effects. At 6 months, participants in the CBT group reported significant changes in the difficulty of performing personally relevant activities (SMD, −0.62) and their expected harmfulness before engaging in these activities (SMD, −0.13) (P ≤.05 for both).

“We thus strongly recommend integrating exposure elements in the management of [chronic lower back pain] to raise its efficacy,” the researchers wrote. “Since CBT seemed to produce delayed effects, core CBT interventions such as cognitive restructuring might be added after exposure treatment to sustain therapeutic effects.”

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Reference

Schemer L, Vlaeyen JWS, Doerr JM, et al. Treatment processes during exposure and cognitive-behavioral therapy for chronic back pain: a single-case experimental design with multiple baselines. Behav Rev Ther. 2018;108:58-67.

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