A physiotherapist examining a patient's lower back.

Getting Back on Track With a Psychological Assist

One in three Canadians have back pain, and working from home hasn't helped. How can psychological treatments help ease the discomfort?


After two years of working from home during the pandemic, back pain is on the rise among non-essential workers. And while physiotherapy and exercise have both been shown to help, a new study has found that combining these treatments with psychological interventions can lead to even better patient outcomes.

The study included contributions from Jill Hayden, an associate professor in the Department of Community Health and Epidemiology at Dalhousie University, and was published in The BMJ.

Nearly one-third of all Canadians suffer from back pain, and when this pain occurs over long periods of time, it often leads to a psychological component that can prolong recovery. Patients with chronic back pain report anxiety and depression, and tend to avoid movement out of fear of worsening their physical symptoms. Unfortunately the opposite is usually true, and avoiding movement can actually make back pain even worse.

While treatments such as physiotherapy and exercise can help relieve some of this pain, psychological interventions are important when it comes to convincing patients to get moving. Yet little research has been done into which psychological treatments are most effective, and how they might complement a more traditional physiotherapy-focused treatment.

“[D]octors and patients [are] often unclear about the best choice of treatment,” said Emma Ho, a PhD candidate at the University of Sydney and lead author of the study, in a press release.

“It is this uncertainty that motivated us to conduct the study.”

To learn more, the researchers gathered data from 97 previously published clinical trials involving more than 13,000 patients with chronic low back pain. The trials involved treatments that combined exercise and psychological interventions such as cognitive behavioural therapies, mindfulness, and pain education programs.

The researchers then tracked the outcomes of patients who had been involved in each of the trials. For comparison, they also included studies that only used exercise as a form of treatment.

Overall, they found that treatment plans including psychological interventions led to improved patient outcomes than exercise-only treatments. All of the psychological interventions employed in the trials led to improved physical function and reduced pain intensity for patients.

Among the different psychological treatments, the researchers found that pain education programs were the most sustainable when it came to improving physical function and reducing avoidant behaviours. Patients who learned about their pain showed improved physical function for up to six months following the treatment, and no longer feared worsening their pain through movement.

When it came to reducing pain intensity, the team found that behavioural therapy was the most effective. Patients who participated in behavioural therapy along with exercise continued to report reduced pain for up to 12 months following their treatments.

Going forward, the authors hope that their results will help guide treatment plans for chronic pain sufferers. Doctors can use these findings to determine which psychological intervention will be most useful for a given patient.

“Ultimately, to optimize improvement in patient outcomes, clinicians should consider [… combining] structured exercise and psychological strategies,” the authors conclude.

While physiotherapy and exercise are crucial in treating chronic back pain, psychological interventions are an important way for patients to augment these treatments and address all of their symptoms.

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Emily Deibert is a PhD student in the Department of Astronomy & Astrophysics at the University of Toronto with a passion for science outreach and communication. She earned her HBSc (Astronomy, English, and Mathematics) at the University of Toronto. She is excited about turning scientific research into stories and sharing these stories with the public.