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Chronic Back Pain


Chronic Back Pain

Chronic Back Pain

An Innovative Service for

To find out more about the Counselling Service or to refer

a patient, please contact the Physiotherapy Department on:

T: 020 7234 2500 F: 020 7234 2815

Ruth Jennings, Psychologist can be contacted directly on:

[email protected]

The National Institute for Health and Clinical Excellence (NICE) guidelines

suggest a combination of physiotherapy and psychological treatment

(Cognitve Behavioural Therapy (CBT)) as best practice in the treatment of

chronic lower back pain. It is in keeping with these recommendations that

London Bridge Hospital Physiotherapy Department launched an innovative

CBT pilot programme in April of this year.

CBT for pain management is based upon

a cognitive-behavioural model of pain

(Turk, Meichenbaum & Genest, 1983)


The basis of this model is the idea that

pain is an intricate experience that is

not only influenced by its underlying

pathophysiology, but also by an

individual’s cognitions, affect and

behaviour (Keefe & Gil, 1986).

The particular therapeutic techniques

of CBT frequently include keeping a

diary of important events and associated

feelings, thoughts and behaviours; probing

and testing cognitions, assumptions,

evaluations and beliefs that might be

unhelpful and/or unrealistic; progressively

facing activities which may have been

avoided; and trying out alternative ways

of behaving and reacting. Relaxation,

mindfulness and distraction techniques

are also a very important part of the

therapeutic process and are particularly

important for patients managing pain.

Cognitive behavioural approaches aim

to improve the way that an individual

manages and copes with their pain,

rather than finding a biological solution

to the existing pathology.The approach

is very much related to problem solving

and returning control to the sufferer.

The six-month pilot programme is

proving to be a great success and as

a result all patients at London Bridge

Hospital experiencing chronic pain

will have the opportunity to add

psychological therapy to their treatment.

Considering the importance of a multi-

disciplinary approach to treatment, this is

a great step forward for the department.

The pilot programme identified a

number of common themes that affected

patients with chronic lower back pain:

• Low self-worth

• Feelings of guilt around prioritising

their own needs

• Difficulty in asserting their own needs

• Putting others’ needs before their own

• High levels of stress/anxiety and a

difficulty in managing this

• Feelings of anger/resentment around

their pain

• Loss of independence/old self and

managing this change

• A sense of loss of control

• Not feeling heard

In the United Kingdom, NICE

recommends CBT as the treatment of

choice for a number of mental health

difficulties, including post-traumatic

stress disorder, OCD, bulimia nervosa,

anxiety and clinical depression.

Ruth Jennings