Group cognitive behavioural treatment for low-back pain in primary care: a randomised controlled trial and cost-effectiveness analysis
Abstract
Background Low-back pain is a common and costly problem. We estimated the effectiveness of a group cognitive behavioural intervention in addition to best practice advice in people with low-back pain in primary care.Methods In this pragmatic, multicentre, randomised controlled trial with parallel cost-effectiveness analysis undertaken in England, 701 adults with troublesome subacute or chronic low-back pain were recruited from 56 general practices and received an active management advisory consultation. Participants were randomly assigned by computer-generated block randomisation to receive an additional assessment and up to six sessions of a group cognitive behavioural intervention (n=468) or no further intervention (control; n=233). Primary outcomes were the change from baseline in Roland Morris disability questionnaire and modified Von Korff scores at 12 months. Assessment of outcomes was blinded and followed the intention-to-treat principle, including all randomised participants who provided follow-up data. This study is registered, number ISRCTN54717854.Findings 399 (85%) participants in the cognitive behavioural intervention group and 199 (85%) participants in the control group were included in the primary analysis at 12 months. The most frequent reason for participant withdrawal was unwillingness to complete questionnaires. At 12 months, mean change from baseline in the Roland Morris questionnaire score was 1.1 points (95% CI 0.39-1.72) in the control group and 2.4 points (1.89-2.84) in the cognitive behavioural intervention group (difference between groups 1.3 points, 0.56-2.06; p=0.0008). The modified Von Korff disability score changed by 5.4% (1.99-8.90) and 13.8% (11.39-16.28), respectively (difference between groups 8.4%, 4.47-12.32; p<0.0001). The modified Von Korff pain score changed by 6.4% (3.14-9.66) and 13.4% (10.77-15.96), respectively (difference between groups 7.0%, 3.12-10.81; p<0.0001). The additional quality-adjusted life-year (QALY) gained from cognitive behavioural intervention was 0.099; the incremental cost per QALY was 1786 pound sterling, and the probability of cost-effectiveness was greater than 90% at a threshold of 3000 pound sterling per QALY. There were no serious adverse events attributable to either treatment.Interpretation Over 1 year, the cognitive behavioural intervention had a sustained effect on troublesome subacute and chronic low-back pain at a low cost to the health-care provider.Funding National Institute for Health Research Health Technology Assessment Programme.
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Participants who received CBT had improved measures of disability, reduced pain intensity, reduced depression and better quality of life 1 year after intervention than those receiving standard care.
“Participants who received CBT had improved measures of disability, reduced pain intensity, reduced depression and better quality of life 1 year after intervention than those receiving standard care [48].”
From Identification and Management of Chronic Pain in Primary Care: a Review (2016) · cites this paper as [48]
One study comparing cognitive behavioural therapy with no intervention reported that no serious adverse effects occurred in either group during the intervention period.
“One study comparing cognitive behavioural therapy with no intervention reported that no serious adverse effects (defined as death or admission to hospital, events attributable to the intervention, or events that caused unwarranted distress to a participant) occurred in either group, during the intervention period.47”
From Psychological interventions for chronic, non-specific low back pain: systematic review with network meta-analysis (2022) · cites this paper as [47]
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Self-citation
- Authors
- Lamb, S. E., Hansen, Z., Lall, R., Castelnuovo, E., Withers, E. J., Nichols, V., Potter, R., & Underwood, M. R.
- Affiliations
- University of Warwick (GB)
- Corresponding author
- Lamb, Sarah E
- ORCID
- Venue
- The Lancet
- Publisher
- Elsevier BV
- Published
- 2010-03
- Volume
- 375
- Issue
- 9718
- Pages
- 916-923
- ISSN
- 0099-5355 (ISSN-L)
- 0140-6736
- OpenAlex
- W2114898872
- Cited by
- 393
- References
- 28
- Citations by year
- 2026: 7 · 2025: 12 · 2024: 13 · 2023: 8 · 2022: 21 · 2021: 16 · 2020: 27 · 2019: 24 · 2018: 19 · 2017: 32 · 2016: 31 · 2015: 29 · 2014: 30 · 2013: 28 · 2012: 35
- FWCI
- 28.78
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- The Lancet (publishedVersion)
- PubMed (publishedVersion)
- UEA Digital Repository (University of East Anglia) (submittedVersion)
- Funders
- National Institute for Health and Care Research (01/75/01)
- Topics
- Health Sciences › Medicine › Pharmacology › Musculoskeletal pain and rehabilitation
- Health Sciences › Medicine › Anesthesiology and Pain Medicine › Pain Management and Treatment
- Health Sciences › Health Professions › Physical Therapy, Sports Therapy and Rehabilitation › Medical Practices and Rehabilitation
- Keywords
- low back pain, group cognitive behavioral therapy, chronic low back pain, subacute low back pain, primary care, cost-effectiveness, disability, pain intensity, quality-adjusted life years, psychological intervention, general practitioner visits, Roland-Morris Disability Questionnaire, willingness to pay, willingness to accept
- MeSH terms
- Adolescent, Adult, Aged, Aged, 80 and over, Chronic Disease, Cost-Benefit Analysis, Female, United Kingdom, Humans, Male, Middle Aged, Primary Health Care, Psychotherapy, Group, Cognitive Behavioral Therapy, Treatment Outcome, Low Back Pain, Young Adult
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