Behavioural treatment for chronic low-back pain

作者：Nicholas Henschke, Raymond Ostelo, Maurits W. van Tulder, Johan W.S. Vlaeyen, Stephen Morley, Willem JJ Assendelft, Chris J. Main · 发表于：Cochrane Database of Systematic Reviews · 年份：2010 · DOI：10.1002/14651858.cd002014.pub3 · 被引用次数：717 · 研究领域：Musculoskeletal pain and rehabilitation、Pain Mechanisms and Treatments、Pain Management and Placebo Effect

BACKGROUND: Behavioural treatment is commonly used in the management of chronic low-back pain (CLBP) to reduce disability through modification of maladaptive pain behaviours and cognitive processes. Three behavioural approaches are generally distinguished: operant, cognitive, and respondent; but are often combined as a treatment package. OBJECTIVES: To determine the effects of behavioural therapy for CLBP and the most effective behavioural approach. SEARCH STRATEGY: The Cochrane Back Review Group Trials Register, CENTRAL, MEDLINE, EMBASE, and PsycINFO were searched up to February 2009. Reference lists and citations of identified trials and relevant systematic reviews were screened. SELECTION CRITERIA: Randomised trials on behavioural treatments for non-specific CLBP were included. DATA COLLECTION AND ANALYSIS: Two review authors independently assessed the risk of bias in each study and extracted the data. If sufficient homogeneity existed among studies in the pre-defined comparisons, a meta-analysis was performed. We determined the quality of the evidence for each comparison with the GRADE approach. MAIN RESULTS: We included 30 randomised trials (3438 participants) in this review, up 11 from the previous version. Fourteen trials (47%) had low risk of bias. For most comparisons, there was only low or very low quality evidence to support the results. There was moderate quality evidence that:i) operant therapy was more effective than waiting list (SMD -0.43; 95%CI -0.75 to -0.11...