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Cited by 718Musculoskeletal pain and rehabilitationPain Management and TreatmentPain Mechanisms and Treatments

Behavioural treatment for chronic low-back pain

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Henschke, Nicholas, Ostelo, Raymond WJG, van Tulder, Maurits W, Vlaeyen, Johan WS, Morley, Stephen, Assendelft, Willem JJ, Main, Chris J.·2010·Cochrane Database of Systematic Reviews
DOI 10.1002/14651858.cd002014.pub3PMC PMC7065591
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Abstract

BACKGROUND: Behavioural treatment is commonly used in the management of chronic low-back pain (CLBP) to reduce disability through modification of maladaptive pain behaviours and cognitive processes. Three behavioural approaches are generally distinguished: operant, cognitive, and respondent; but are often combined as a treatment package. OBJECTIVES: To determine the effects of behavioural therapy for CLBP and the most effective behavioural approach. SEARCH STRATEGY: The Cochrane Back Review Group Trials Register, CENTRAL, MEDLINE, EMBASE, and PsycINFO were searched up to February 2009. Reference lists and citations of identified trials and relevant systematic reviews were screened. SELECTION CRITERIA: Randomised trials on behavioural treatments for non-specific CLBP were included. DATA COLLECTION AND ANALYSIS: Two review authors independently assessed the risk of bias in each study and extracted the data. If sufficient homogeneity existed among studies in the pre-defined comparisons, a meta-analysis was performed. We determined the quality of the evidence for each comparison with the GRADE approach. MAIN RESULTS: We included 30 randomised trials (3438 participants) in this review, up 11 from the previous version. Fourteen trials (47%) had low risk of bias. For most comparisons, there was only low or very low quality evidence to support the results. There was moderate quality evidence that:i) operant therapy was more effective than waiting list (SMD -0.43; 95%CI -0.75 to -0.11) for short-term pain relief;ii) little or no difference exists between operant, cognitive, or combined behavioural therapy for short- to intermediate-term pain relief;iii) behavioural treatment was more effective than usual care for short-term pain relief (MD -5.18; 95%CI -9.79 to -0.57), but there were no differences in the intermediate- to long-term, or on functional status;iv) there was little or no difference between behavioural treatment and group exercise for pain relief or depressive symptoms over the intermediate- to long-term;v) adding behavioural therapy to inpatient rehabilitation was no more effective than inpatient rehabilitation alone. AUTHORS' CONCLUSIONS: For patients with CLBP, there is moderate quality evidence that in the short-term, operant therapy is more effective than waiting list and behavioural therapy is more effective than usual care for pain relief, but no specific type of behavioural therapy is more effective than another. In the intermediate- to long-term, there is little or no difference between behavioural therapy and group exercises for pain or depressive symptoms. Further research is likely to have an important impact on our confidence in the estimates of effect and may change the estimates.

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  • Henschke et al also grouped behavioural therapies together with cognitive behavioural therapy into one comparison called behavioural treatment in separate meta-analyses comparing psychological interventions with usual care, group exercise, or physiotherapy care.

    “However, these authors also grouped behavioural therapies (that is, operant and respondent therapy) together with cognitive behavioural therapy into one comparison (called behavioural treatment) in separate meta-analyses comparing psychological interventions with either usual care, group exercise, or physiotherapy care.14”

    From Psychological interventions for chronic, non-specific low back pain: systematic review with network meta-analysis (2022) · cites this paper as [14]

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Authors
Henschke, N., Ostelo, R. W., van Tulder, M. W., Vlaeyen, J. W., Morley, S., Assendelft, W. J., & Main, C. J.
Affiliations
  • The George Institute for Global Health (AU)
  • Amsterdam Public Health (NL)
  • VU University; Department of Health Sciences, Faculty of Earth and Life Sciences; PO Box 7057 Room U454 Amsterdam Netherlands 1007 MB
  • Maastricht University (NL)
  • University of Leeds (GB)
  • Leiden University Medical Center (NL)
  • Keele University (GB)
ORCID
Venue
Cochrane Database of Systematic Reviews
Publisher
Wiley
Published
2010-07-07
Volume
2011
Issue
2
Pages
CD002014-CD002014
ISSN
  • 1361-6137 (ISSN-L)
  • 1465-1858
DOI
10.1002/14651858.cd002014.pub3
PMC
PMC7065591
OpenAlex
W2117118000
Cited by
718
References
112
Citations by year
2026: 3 · 2025: 23 · 2024: 18 · 2023: 19 · 2022: 18 · 2021: 38 · 2020: 30 · 2019: 40 · 2018: 40 · 2017: 36 · 2016: 41 · 2015: 46 · 2014: 47 · 2013: 45 · 2012: 53
FWCI
6.36
Type
journal article
Language
en
Open access
Locations
  • Cochrane Database of Systematic Reviews (publishedVersion)
  • PubMed Central (publishedVersion)
  • PubMed (publishedVersion)
  • Research Publications (Maastricht University) (publishedVersion, other-oa)
  • Amsterdam UMC (VU Amsterdam) - Institutional Repository (publishedVersion)
  • Leiden Repository (Leiden University) (submittedVersion)
  • Data Archiving and Networked Services (DANS) (submittedVersion, other-oa)
  • Pure Amsterdam UMC (submittedVersion)
  • VU Research Portal (submittedVersion)
  • Research Publications (Maastricht University) (submittedVersion)
  • Data Archiving and Networked Services (DANS) (submittedVersion)
Topics
  • Health Sciences › Medicine › Pharmacology › Musculoskeletal pain and rehabilitation
  • Health Sciences › Medicine › Anesthesiology and Pain Medicine › Pain Management and Treatment
  • Health Sciences › Medicine › Physiology › Pain Mechanisms and Treatments
Keywords
chronic low back pain, behavior therapy, cognitive therapy, analgesia, functional status, depressive symptoms, group exercise, inpatient rehabilitation, non-specific low back pain, waiting list comparison, usual care comparison, disability reduction, treatment effectiveness comparison, quality of evidence, GRADE assessment, risk of bias, short-term versus long-term outcomes, pain catastrophizing
MeSH terms
Behavior Therapy, Chronic Disease, Conditioning, Operant, Depression, Humans, Muscle Relaxation, Waiting Lists, Randomized Controlled Trials as Topic, Low Back Pain

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