Rumination-Focused Cognitive-Behavioral Therapy for Chronic Low Back Pain: A Randomized Controlled Trial
DOI:
https://doi.org/10.31661/gmj.v9i.1722Keywords:
Rumination; Low Back Pain; Depression; AnxietyAbstract
Background: Chronic pain remains or reappears for more than 3 to 6 months, and it is influencing 20% of the global population. The pain catastrophizing affects pain intensity and psychological conditions of patients with chronic pain. Rumination-focused cognitive-behavioral therapy (RFCBT) targets rumination as the key component of pain catastrophizing. The aim of this study was to determine the effectiveness of RFCBT on depression, anxiety, and pain severity of individuals with chronic low back pain (LBP). Materials and Methods: In a randomized controlled trial, 30 patients aged between 20-55 years with diagnosed chronic LBP were chosen by convenience sampling and randomly allocated into intervention and control groups. All patients used their prescribed medications for pain management, but the intervention group received 12 weekly sessions of RFCBT, which was manualized psychotherapy to change unconstructive rumination to constructive rumination. Depression Anxiety and Stress scale-21 and chronic pain grade questionnaire were administered as pre-tests and re-administered after 3 and 6 months as post-test and follow-up assessments, respectively. Results: RFCBT significantly reduced depression (F1=23.01, P=0.001), anxiety (F1=25.7, P=0.001) and pain severity (F1=7.17, P=0.012) in patients with chronic LBP. Conclusion: RFCBT may offer benefits for treating patients with chronic low back pain when added to their usual pharmacological treatment. This benefit may be the result of targeting rumination as the key element of pain catastrophizing. [GMJ.2020;9:e1722]
References
Jackson TP, Stabile VS, McQueen KK. The global burden of chronic pain. ASA Newsl. 2014;78(6):24-27. Available from: https://monitor.pubs.asahq.org/article.aspx?articleid=2432061 (accessed 24 Sept 2019).
Treede R-D, Rief W, Barke A, Aziz Q, Bennett MI, Benoliel R, et al. A classification of chronic pain for ICD-11. Pain. 2015;156(6):1003-1007.
https://doi.org/10.1097/j.pain.0000000000000160
PMid:25844555 PMCid:PMC4450869
Soo H, Burney S, Basten C. The role of rumination in affective distress in people with chronic physical illness: A review of the literature and theoretical formulation. J Health Psychol. 2009;14(7):956-966.
https://doi.org/10.1177/1359105309341204
PMid:19786522
Oliveira DS, Vélia Ferreira Mendonça L, Sofia Monteiro Sampaio R, de Castro-Lopes MPD, Ribeiro de Azevedo LF. The Impact of Anxiety and Depression on the Outcomes of Chronic Low Back Pain Multidisciplinary Pain Management: A Multicenter Prospective Cohort Study in Pain Clinics with One-Year Follow-up. Pain Med. 2018;20(4):736-764.
https://doi.org/10.1093/pm/pny128
PMid:30010966
Sturgeon JA. Psychological therapies for the management of chronic pain. Psychol Res Behav Manag. 2014;7:115-124.
https://doi.org/10.2147/PRBM.S44762
PMid:24748826 PMCid:PMC3986332
Severeijns R, Vlaeyen JW, van den Hout MA, Weber WE. Pain catastrophizing predicts pain intensity, disability, and psychological distress independent of the level of physical impairment. Clin J Pain. 2001;17(2):165-172.
https://doi.org/10.1097/00002508-200106000-00009
PMid:11444718
Quartana PJ, Campbell CM, Edwards RR. Pain catastrophizing: a critical review. Expert Rev Neurother. 2009;9(5):745-758.
https://doi.org/10.1586/ern.09.34
PMid:19402782 PMCid:PMC2696024
Schütze R, Rees C, Smith A, Slater H, Campbell JM, O'Sullivan P. How can we best reduce pain catastrophizing in adults with chronic noncancer pain: A systematic review and meta-analysis. J Pain. 2018;19(3):233-256.
https://doi.org/10.1016/j.jpain.2017.09.010
PMid:29122652
Sullivan MJ, Bishop SR, Pivik J. The pain catastrophizing scale: development and validation. Psychol Assess. 1995;7(4):524-532.
https://doi.org/10.1037/1040-3590.7.4.524
Ogunlana MO, Odole AC, Adejumo A, Odunaiya N. Catastrophising, pain, and disability in patients with nonspecific low back pain. Hong Kong Physiother J. 2015;33(2):73-79.
https://doi.org/10.1016/j.hkpj.2015.03.001
PMid:30930571 PMCid:PMC6385129
Van Damme S, Crombez G, Bijttebier P, Goubert L, Van Houdenhove B. A confirmatory factor analysis of the Pain Catastrophizing Scale: invariant factor structure across clinical and non-clinical populations. Pain. 2002;96(3):319-324.
https://doi.org/10.1016/S0304-3959(01)00463-8
Sansone RA, Sansone LA. Rumination: relationships with physical health. Innov Clin Neurosci. 2012;9(2):29-34. (Accessed 15 Sept. 2019, at http://innovationscns.com/rumination-relationships-with-physical-health/)
Watkins ER, Mullan E, Wingrove J, Rimes K, Steiner H, Bathurst N, et al. Rumination-focused cognitive-behavioural therapy for residual depression: Phase II randomised controlled trial. Br J Psychiatry. 2011;199(4):317-322.
https://doi.org/10.1192/bjp.bp.110.090282
PMid:21778171
Hvenegaard M, Moeller SB, Poulsen S, Gondan M, Grafton B, Austin SF, et al. Group rumination-focused cognitive-behavioural therapy (CBT) v. group CBT for depression: phase II trial. Psychol Med. 2019:1-9.
https://doi.org/10.1017/S0033291718003835
PMid:30630555
Cook L, Mostazir M, Watkins E. Reducing Stress and Preventing Depression (RESPOND): Randomized Controlled Trial of Web-Based Rumination-Focused Cognitive Behavioral Therapy for High-Ruminating University Students. J Med Internet Res. 2019;21(5):e11349.
PMid:31094331 PMCid:PMC6536298
Lovibond PF, Lovibond SH. The structure of negative emotional states: Comparison of the Depression Anxiety Stress Scales (DASS) with the Beck Depression and Anxiety Inventories. Behav Res Ther. 1995;33(3):335-343.
https://doi.org/10.1016/0005-7967(94)00075-U
Antony MM, Bieling PJ, Cox BJ, Enns MW, Swinson RP. Psychometric properties of the 42-item and 21-item versions of the Depression Anxiety Stress Scales in clinical groups and a community sample. Psychol Assess. 1998;10(2):176-181.
https://doi.org/10.1037/1040-3590.10.2.176
Smith BH, Penny KI, Purves AM, Munro C, Wilson B, Grimshaw J, et al. The Chronic Pain Grade questionnaire: validation and reliability in postal research. Pain. 1997;71(2):141-147.
https://doi.org/10.1016/S0304-3959(97)03347-2
Hawker GA, Mian S, Kendzerska T, French M. Measures of adult pain: Visual analog scale for pain (vas pain), numeric rating scale for pain (nrs pain), mcgill pain questionnaire (mpq), shortâ€form mcgill pain questionnaire (sfâ€mpq), chronic pain grade scale (cpgs), short formâ€36 bodily pain scale (sfâ€36 bps), and measure of intermittent and constant osteoarthritis pain (icoap). Arthritis Care Res. 2011;63(S11): S240-S252.
https://doi.org/10.1002/acr.20543
PMid:22588748
Von Korff M, Ormel J, Keefe FJ, Dworkin SF. Grading the severity of chronic pain. Pain. 1992;50(2):133-149. h
https://doi.org/10.1016/0304-3959(92)90154-4
Watkins ER. Rumination-focused cognitive-behavioral therapy for depression. 2nd ed. New York: Guilford Press; 2018.
Smeets RJ, Vlaeyen JW, Kester AD, Knottnerus JA. Reduction of pain catastrophizing mediates the outcome of both physical and cognitive-behavioral treatment in chronic low back pain. J Pain. 2006;7(4):261-271.
https://doi.org/10.1016/j.jpain.2005.10.011
PMid:16618470
Published
Issue
Section
License
Copyright (c) 2020 Galen Medical Journal
This work is licensed under a Creative Commons Attribution 4.0 International License.