Cognitive behavioral therapy (CBT) for subacute low back pain: a systematic review
Abstract
Purpose of review Chronic low back pain (CLBP) is a major source of physical and psychiatric morbidity and mortality, and the current overreliance on opioid analgesics has contributed to a burgeoning epidemic in the USA. Cognitive behavioral therapy (CBT) is an empirically supported treatment for CLBP, but little information exists regarding its potential efficacy for CLBP's precursor condition, subacute low back pain (sALBP), defined here as having a 7-12-week duration. Earlier intervention with CBT at the sALBP stage could produce larger clinical benefits. This systematic review was undertaken to characterize and highlight this knowledge gap.Recent findings Of 240 unique articles identified by comprehensive database searches, only six prospective, sALBP-focused, randomized controlled trials (RCTs) published within the past 20 years met criteria for inclusion in this review. These studies varied widely in their sample sizes, precise definition of sALBP, nature of CBT intervention, and outcome measures. Five of the six showed significant improvements associated with CBT, but the heterogeneity of the studies prevented quantitative comparisons. CBT has not been adequately studied as a potential early intervention treatment for sALBP patients. None of the six identified papers studied US civilians or leveraged innovations such as teletherapy-able to reach patients in remote or underserved areas-underscoring critical gaps in current back pain treatment. Given the severity of the US opioid epidemic, non-pharmacologic options such as CBT should be rigorously explored in the sALBP population.
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Three reviews evaluated CBT following injury, and all reported CBT to improve distress-related outcomes, although overall quality of evidence was described as low.
“Three reviews evaluated CBT following injury,4143 and all reviews reported CBT to improve distress-related outcomes although, overall the quality of evidence was described as low.”
From Impact of healthcare interventions on distress following acute musculoskeletal/orthopaedic injury: A scoping review of systematic reviews (2024) · cites this paper as [43]
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- Authors
- Mariano, T. Y., Urman, R. D., Hutchison, C. A., Jamison, R. N., & Edwards, R. R.
- Affiliations
- Brigham and Women's Hospital (US)
- Corresponding author
- Mariano, Timothy Y.
- Venue
- Current Pain and Headache Reports
- Published
- 2018-02-23
- Volume
- 22
- Issue
- 3
- Pages
- 15-15
- ISSN
- 1531-3433 (ISSN-L)
- 1534-3081
- OpenAlex
- W2789820066
- Cited by
- 35
- References
- 36
- Citations by year
- 2026: 2 · 2025: 3 · 2024: 5 · 2023: 5 · 2022: 6 · 2021: 7 · 2020: 3 · 2019: 1 · 2018: 3
- FWCI
- 0.41
- Type
- journal article
- Language
- en
- Open access
- closed
- Licence
- www.springer.com/tdm (tdm)
- Locations
- Current Pain and Headache Reports (publishedVersion)
- PubMed (publishedVersion)
- 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
- cognitive behavioral therapy, subacute low back pain, chronic low back pain, early intervention, opioid epidemic, non-pharmacological treatment, external beam radiotherapy, randomized controlled trials
- MeSH terms
- Humans, Cognitive Behavioral Therapy, Low Back Pain
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