Chronic back pain: integrating psychological and physical therapy--an overview.

Chronic back pain is a major consumer of costly healthcare resources in the Western world. Patients' suffering affects their families and associates, leads to diminished self-confidence, and prevents their effective participation in the workplace. Although medical treatments and analgesics are generally successful in treating acute back pain, and some patients recover spontaneously, conventional approaches are less successful in dealing with chronic pain and may be contraindicated. In the first of two articles, the author offers an overview of research on cognitive-behavioral programs, using operant activity and relaxation training, that have led to reductions in patients' pain and to increases in their activity levels. Part 2 provides a step-by-step description of how to incorporate basic psychological techniques and physical therapy procedures for chronic pain sufferers. Patient and therapist cooperate in operant activities, with the patient monitoring progress and carrying out regular home-work assignments as he or she seeks to perform target activities; applied relaxation encourages the patient to cope with pain by disrupting the connection between anxiety, despair, and pain. The techniques outlined are suitable for dealing with other musculoskeletal conditions as well as with chronic back pain.