Multimodal pain management and cognitive behavioral therapy

Cognitive behavioral therapy has been scientifically proven to relieve chronic low back pain and to reduce the perceived disabling effects of the pain. One good study showed that – compared to conventional conservative treatment – cognitive behavioral therapy was able to noticeably improve symptoms in an additional 1 to 2 out of 10 people. Studies suggest that this positive effect may last over the long term too.

Even though cognitive behavioral therapy can't make chronic low back pain go away completely, it can relieve the pain and make it easier to cope with. Relaxation techniques are often used as part of the CBT treatment as well.

If chronic low back pain causes considerable suffering or is accompanied by another condition like depression, statutory health insurers in Germany may cover the costs of behavioral therapy.

But it can take quite some time to get an appointment for psychological treatment for the management of pain in Germany.

Multimodal pain management is provided by specialists from various areas of expertise, such as doctors, physiotherapists and psychologists. The treatment involves a combination of exercise, patient education, relaxation techniques and medication. Psychotherapists show patients psychological strategies that help them cope with chronic pain and stress at work or home. This is either done in groups or one-on-one sessions. Multimodal pain management is offered as part of standard pain therapy or rehabilitation programs.

Multimodal pain management can reduce back pain in the long term, too. Because cognitive behavioral therapy has also been shown to be helpful in the long term, it should be included in multimodal pain management programs.

These programs are mainly offered by pain centers, psychosomatic medicine departments in hospitals, and rehabilitation centers with a focus on rheumatology, orthopedics and psychosomatic medicine. In some programs you may stay at the hospital or center the whole time, and in others you may have some or all of the treatments as an outpatient. The programs last at least seven days, but they usually last two to four weeks.

This multimodal treatment approach is considered if other treatments haven’t helped enough and the symptoms are having a great impact on the person’s quality of life or ability to function in everyday life. The treatment can be prescribed by a practice-based doctor, for instance a family doctor, orthopedist or pain specialist. People generally have to wait about three months before they get a place in a multimodal pain management program.