Cognitive Therapy Eases Chronic Back Pain

Researchers who authored a study published in the January 20, 2006, issue of Musculoskeletal Disorders, an open-access journal from BioMed Central, found that people with chronic low back pain can benefit as much from cognitive behavioral therapy as they do from physical therapy.

“Cognitive therapy for management of chronic low back pain is well documented and is an important part of treating the whole person,” says Pamela J. Leitner PT, DPT, OCS. “While mechanical problems respond best to mechanical treatment, we as therapists cannot discount the power of the mind in healing and in learning to cope with chronic pain. A behavioral approach should be a part of the education process for all patients with low back pain in conjunction with physical conditioning, manual therapy techniques as appropriate, postural correction, protective body mechanics, and ergonomic instruction.”

 The study included 212 people with chronic low back pain who were randomly assigned to one of four groups: those who received active physical therapy (APT), cognitive behavioral therapy (CBT), a combination of APT and CBT, or no treatment at all.

Active physical therapy was designed to restore aerobic capability and increase back-muscle strength. Participants in the study had to ride a bicycle and perform back-strengthening exercises. Cognitive behavioral therapy helped the patients cope with their pain and taught them how to overcome their reluctance to undergo physical activity.

The treatments lasted 10 weeks, and participants completed psychological- and physical-function questionnaires at the start and end of the study.

The groups who received only APT or only CBT treatment saw an improvement in their function, a decrease in their complaints, and an improvement in their pain scores, compared to the group that received no treatment. The combination APT and CBT treatment group improved as much as either group alone.

“People with chronic back pain tend to start avoiding things that may actually be helpful to them, but cognitive behavioral therapy changed how they think about themselves,” says Scott Eathorne, MD, medical director of athletic medicine at Providence Hospital in Southfield, Mich. “CBT not only addresses the physical aspects of the pain, but starts to look at how they think about their pain and how they behave.”

PTs Called to Action at the Winter Olympics

In February 2006, Kurt Jepson, PT, SCS, of Scarborough, and Mike Hersey, PT, CSCS, of Saco, headed to Italy to serve as physical therapists (PTs) for a pair of United States Winter Olympics teams: Jepson worked with the men’s Nordic ski team in Sestriere, Italy, while Hersey served the men’s snowboarding team in Bardonecchia, Italy.

 “The consistency of sports-medicine providers is important to each athlete,” Jepson says. “It is one less variable they have to think about, which may distract them from their performance goals.”

Selected from a medical pool of more than 50 applicants, Jepson and Hersey each were required to volunteer 2 weeks at the Olympic Training Center in Colorado Springs, Colo, in preparation for the Olympics. At the Olympics, both PTs provided sports medicine at the clinics, on-site emergency management of the athletes, and other treatments.

“It has been an honor to be chosen to work with such high-level athletes for the past 6 years,” Hersey says. “I was excited to have helped these athletes reach their goal as best in the world this year at the Olympic games.”

This is Jepson’s eighth year working with the Nordic ski team and Hersey’s sixth year working with the snowboarding team. Jepson is in his second stint as a PT for the Olympics; he served as PT during the 2002 Winter Olympics in Salt Lake City, Utah.

Successful Presurgery Team Includes PTs

A study published in the October 2005 issue of the Journal of Arthroplasty reports that 96% of patients who had minimally invasive total knee-replacement surgery were able to go home the same day as the surgery, without complications—thanks to a presurgical team approach.

“It’s a comprehensive management pathway that helps the patient avoid overnight stay,” says Richard A. Berger, MD, lead author and surgeon. “It’s optimal sequencing and timing of interventions by the nursing, physical therapy, and anesthesia surgical teams; it’s a team approach of equally weighted preoperative, intraoperative, and postoperative care.”

According to Sheila Sanders, RN, BSN, ONC, Berger’s presurgical team consists of two registered nurses and a physical therapist (PT).

“When the patients sign up for surgery, a day of preoperative education is also set up for them,” Sanders says. “They are given appointments to see a medical doctor and to attend a 2-hour seminar, which consists of what the surgical procedure will entail, the length of the stay, the criteria for discharge, and  the pain medications. Each patient is [literally] walked through a session of physical therapy. Once the patients leave, they are completely informed of what to expect and what the recovery process will be like.”

Patients see a PT and an occupational therapist postsurgery. To be released from the hospital the same day, patients must be able to get in and out of bed, rise from a chair, walk 100 feet, and walk up and down a full flight of stairs. They are asked if they feel comfortable and would like to go home; then, they are released with pain medication. Patients receive home physical therapy until they can drive to the physical therapy center; then, outpatient physical therapy is begun.