Behavioral Approaches on Managing Chronic Low Back Pain By Akshaya.M

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INTRODUCTION TO CHRONIC LOW BACK PAIN :

Low back pain that has been present for longer than three months is considered as CHRONIC LOW BACK PAIN.Nearly a third of people seeking treatment for low back pain will have persistent moderate pain for one year after an acute episode. Back pain can range in intensity from a dull,constant ache to a sudden,sharp or shooting pain.It can begin suddenly as a result of an accident or by lifting somethin heavy,or it can develop over time as we age.Getting too little exercise followed by a strenuous workout also can cause back pain.

Causes of chronic LBP:

A single event may not have caused the pain. Many people with chronic back pain have arthritis or they may have extra wear and tear of the spine,which may be due to

  • Heavy use from work or sports
  • Injuries or fractures
  • Surgery

Other possible causes of chronic LBP include

  • Curvature of the spine,such as scoliosis or kyphosis
  • Medical problems,such as fibromyalgia or rheumatoid arthritis
  • Piriformis syndrome,a pain disorder involving a muscle in the buttocks called the piriformis muscle.

BEHAVIOURAL APPROACHES:

The treatment of chronic low back pain is not primarily focused on removing an underlying disease but at the reduction of disability through the modification of environmental contingencies and cognitive processes. Behavioral interventions are commonly used in the treatment of chronic low back pain.The latter especially important,as patients who suffer from low back pain often suffer from depression and have impaired quality of life ,as they are unable to work and engage in their social activities because of their disability.Over the years behavioral therapy as evolved and currently three “waves”of behavioral therapy recognized,the characteristics of which are summarized in table.

 Behavioral psychotherapy typeTheoretical background
First waveBehavioral therapyBehavioral analysis takes into consideration every behavior,including overt and covert.The therapies focuses on specific learned behaviors and how the environment influences such behaviors.
Second waveCognitive behavioral therapyCBT focuses on the development of individual strategies aimed to solve current problems and to change unhelpful patterns in cognitions (i.e,thoughts and beliefs)and emotional regulation
Third waveAcceptance and commitment therapy Dialectical behavioral therapy Integrative behavioral therapy Behavioral activationThird wave therapies prioritize the holistic promotion of health and well-being and are less focused on reducing psychological and emotional symptoms.These therapies abandon key assumptions associated with traditional cognitive therapy and is informed by emerging research in cognitive psychology and neuroscience.Concepts such as metacognition,acceptance,mindfulness,personal values,and spirituality are frequently incorporated as traditional behavioral interventions.  

HOW EXERCISE THERAPY IS HELPFUL IN BACK PAIN:

In general,the goals of exercise therapy are to decrease pain,increase function,and provide education on a maintenance program to prevent further recurrences.

A exercise therapy program for back pain usually has two components:

  • Passive physical  therapy to help reduce the patients pain to a more manageable level
  • Active exercise

Active therapy-Back pain exercises

  Active exercise is necessary to rehabilitate the spine.Generally,a patients back exercise program should encompass a combination of the following:

  • Stretching for back pain exercise(hamstring stretching)
  • Strengthening for back pain exercise(dynamic lumbar stabilization)
  • Low-impact aerobic conditioning(such as walking,bicycling etc.,)

Passive physical therapy-Modalities

Heat/ice packs

  • TENS units
  • Iontophoresis
  • Ultrasound

CONCLUSION:

Behavioral approach is a recent global trend on managing chronic low back pain

REFERENCES:

  1. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5993685/
  2. https://www.spine-health.com/treatment/physical-therapy/physical-therapy-benefits-back-pain

3.https://www.physio-pedia.com/Chronic_Low_Back_Pain

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