# Psychophysical physiotherapy used as a treatment for adults with chronic low back pain

> Low back pain (LBP) affects people across all age groups, often restricting movement, lowering quality of life, and impacting mental well-being, work capacity, and social participation.

## Introduction to Low Back Pain
Low back pain (LBP) is defined as pain occurring between the lower ribs and the buttocks. It can be acute, sub-acute, or chronic. The condition may be specific, when linked to a known disease or spinal problem, or non-specific, when no clear structural cause is identified (accounting for about 90% of cases). 

Rehabilitation is essential in every stage of LBP to help individuals understand their pain, maintain or restore activity, and adopt recovery strategies. Given its prevalence and link to reduced productivity, LBP is a major public health challenge with significant economic consequences.

## Psychophysical Physiotherapy Interventions
Chronic low back pain (CLBP) is a leading cause of disability worldwide. Because conventional physiotherapy often provides only partial relief and relapse rates remain high, psychophysical physiotherapy methods have gained increasing attention. These include:
*   **Cognitive Behavioral Therapy (CBT)**
*   **Mindfulness-Based Stress Reduction (MBSR)**
*   **Cognitive Functional Therapy (CFT)**

These approaches integrate physical rehabilitation with psychological strategies, targeting both the body and mind to improve outcomes.

## Methodology
This mini-review was conducted as part of the "Professional in Physiotherapy" course at Savonia University of Applied Sciences. The authors practiced systematic literature review elements, including information retrieval and critical appraisal using the PEDro Scale.

*   **Database:** PubMed
*   **Criteria:** Randomized controlled trials (RCTs) published in the last ten years, fully available in free text.
*   **Keywords:** "cognitive behavioral therapy" and "chronic low back pain."
*   **Selection:** Out of 42 initial results, four studies met the eligibility criteria.
*   **Quality Assessment:** The PEDro scale was used to assess methodological quality, focusing on risk of bias and overall study rigor.

## Key Findings
Recent evidence highlights the effectiveness of psychological and behavioral interventions for adults with CLBP, particularly those targeting maladaptive thoughts, behaviors, and emotional regulation.

*   **Brief vs. Intensive Interventions:** Research by Darnall et al. (2021) demonstrated that a single-session pain management intervention ("Empowered Relief") produced comparable reductions in pain catastrophizing to an eight-session CBT program.
*   **Sustained Benefits:** Cherkin et al. (2016) found that both MBSR and CBT were superior to usual care in improving functional limitations and reducing pain, with effects sustained for up to one year.
*   **Individualized Approaches:** O’Keeffe et al. (2020) showed that Cognitive Functional Therapy (CFT), which integrates behavioral, cognitive, and movement retraining, led to greater short-term improvements in disability and pain compared to standard exercise and education.

## Conclusion
Psychological and behaviorally oriented interventions produce meaningful, lasting improvements in CLBP. The evidence suggests that multifaceted approaches—whether brief or extended—significantly improve outcomes by enhancing self-management, coping, and functional engagement. Future research should focus on the long-term durability of these treatments and identify which specific patient profiles benefit most from each intervention.

## Authors
*   **Josefiina Angerman**, physiotherapy student, Savonia University of Applied Sciences
*   **Vilma Räsänen**, physiotherapy student, Savonia University of Applied Sciences
*   **Sara Siivonen**, physiotherapy student, Savonia University of Applied Sciences
*   **Jenni Vuorio**, physiotherapy student, Savonia University of Applied Sciences
*   **Marja Äijö PT, PhD**, Principal lecturer of Gerontology and Rehabilitation, Savonia University of Applied Sciences

## References
*   ChatGPT 2025. OpenAI. GPT-4o-mini model. Accessed for language check and translating. October 2025. https://chat.openai.com
*   Chen JA, et al. (2023). Moderators and Nonspecific Predictors of Treatment Benefits in a Randomized Trial of Mindfulness-Based Stress Reduction vs Cognitive-Behavioral Therapy vs Usual Care for Chronic Low Back Pain. *J Pain*. https://doi.org/10.1016/j.jpain.2022.09.014
*   Cherkin DC, et al. (2016). Effect of Mindfulness-Based Stress Reduction vs Cognitive Behavioral Therapy or Usual Care on Back Pain and Functional Limitations in Adults With Chronic Low Back Pain: A Randomized Clinical Trial. *JAMA*. https://doi.org/10.1001/jama.2016.2323
*   Darnall, B.D., et al. (2021). Comparison of a Single-Session Pain Management Skills Intervention With a Single-Session Health Education Intervention and 8 Sessions of Cognitive Behavioral Therapy in Adults With Chronic Low Back Pain: A Randomized Clinical Trial. *JAMA Network Open*. https://doi.org/10.1001/jamanetworkopen.2021.13401
*   O’Keeffe, M., et al. (2020). Cognitive functional therapy compared with a group-based exercise and education intervention for chronic low back pain: a multicentre randomised controlled trial (RCT). *British journal of sports medicine*. https://doi.org/10.1136/bjsports-2019-100780
*   PedroScale (1999). Pedro Scale tool. https://pedro.org.au/english/resources/pedro-scale/
*   Physiotherapy Evidence Database. n.d. PEDro rating over 25 years – Similarities and differences. https://pedro.org.au/english/pedro-rating-over-25-years-similarities-and-differences/
*   Picture: Pixabay n.d. https://pixabay.com/fi/
*   World Health Organization. 2023. Low back pain. https://www.who.int/news-room/fact-sheets/detail/low-back-pain