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EULAR: Cognitive Therapy And Exercise As Effective As Lumbar Fusion For Chronic Lower Back Pain and Disc Degeneration
By Adrian Burton
LISBON, PORTUGAL -- June 20, 2003 -- A Norwegian study has shown that cognitive intervention is as effective as lumbar fusion surgery in the treatment of chronic lower back pain and disc degeneration, according to data presented here June 20th at the Annual European Congress of Rheumatology.
Although lumbar fusion surgery for back pain is common, several trials have shown that cognitive intervention, which involves teaching patients about their back problem and how live with it, is also effective.
"Simple cognitive intervention can be both physically and cost effective in patients with chronic low back pain," said Jens Ivar Brox, MD, from the department of orthopaedic surgery, the National Hospital, in Oslo, Norway.
In a multi-centre study, Dr. Brox's team enrolled 64 patients aged 25-60 who had lower back pain for more than 1 year. All showed disc degeneration at L4-5 and/or L5-S1 on x-ray examination. Thirty-seven patients were randomised to receive lumbar fusion with transpedicular screws plus postoperative physiotherapy and 27 received cognitive intervention and exercise.
Those who received cognitive therapy attended a lecture that taught patients that ordinary activity would not damage their discs, and that they could bend their backs (the Indahl talk). The main aim of the talk is to help patients avoid the fear of harming themselves through activity, to teach them not to be over-cautious and to correct negative feelings that would have psychological impact on their condition. Their instruction was completed by teaching them three daily exercise routines.
After 1 year, 97% of those enrolled were evaluated using the validated Oswestry Disability Index (ODI), a self-reported questionnaire on perceived disability based on questions on pain and the ability to carry out daily activities. The index leads to a score of 0 [best] to 100 [worst]).
Those who underwent surgery had a reduction in mean ODI score from 41 to 26, while those who received cognitive intervention had a reduction of from 42 to 30. The difference between the two groups was not significant (P=0.33). No differences were seen in pain, use of analgesics, emotional distress or life satisfaction, and an equal number of patients returned to work from both groups.
"According to an independent observer, the success rate was 71% after surgery and 77% after cognitive intervention and exercise [not significantly different]," explained Dr. Brox.
The findings suggest that back pain treatment costs could be reduced, but also that many patients may no longer need to undergo surgery.
"I think it is interesting that we can now offer patients a choice of whether to undergo surgery or not," Dr. Brox concluded.