Cognitive behavioural therapy for chronic low back pain

Your doctor has recommended cognitive behavioural therapy (CBT) to help with your ongoing low back pain.

How can CBT help with low back pain?

• Your mood, thoughts, feelings and what you do (behaviour) can affect your pain. The opposite is also true: your pain can affect your mood, thoughts, feelings and behaviour. For example, when back pain lasts a long time, it is common to feel frustrated, sad and/or worried. You may also change, reduce, or stop activities because of the pain and these thoughts and feelings.
• CBT is a mind-body treatment that helps you change how you think and behave when in pain and how you manage unhelpful thoughts and feelings.
• This can help you better cope with your back pain and return to activities that are important to you.

How do I get started?

• Your doctor may refer you to an allied health provider such as a psychologist, counsellor or physiotherapist. Check if the allied health provider is trained in CBT.
• Find out what the treatment sessions cost. If you have private health insurance, check that it covers treatment by the allied health provider. Your doctor may provide you a “GP management plan”, which (if you meet certain conditions) may let you claim Medicare rebates for up to five sessions with the allied health provider.
• CBT usually includes education and exercise, and may be used with physiotherapy to treat low back pain.
• The CBT program usually takes about 5 to 20 sessions, either in a group or one-on-one setting.
• CBT usually involves learning and practising a few skills in your everyday life. These skills include:
  1. Identifying activities (behaviours) you have reduced, stopped or avoid because of your back pain. For example, over time you may have reduced how much you lift or carry to the point you do not lift or carry anything anymore.
  2. Identifying any unhelpful thoughts, feelings and beliefs you have about these activities. For example, you no longer pick up or carry any object because you are scared or worried about hurting your back.
  3. Learning how to change these unhelpful thoughts and feelings to allow you to return to activities that are important to you.

What to look out for

• For most people with ongoing low back pain, the exact cause of their pain is not known. However, it is usually not the result of anything serious or dangerous. CBT is safe for back pain.
• CBT may cause an uncomfortable feeling at times. This is because you may need to challenge beliefs that might be affecting your pain and ability to do everyday activities.
• As with most skills, you need to regularly practise CBT.
• Many apps and websites on CBT are available but it is not known if they can reduce low back pain. Ask your doctor if a specific resource can be helpful.