Study: Exercise and Cognitive Therapies As Effective As Back Surgery

The Spine Journal features a new study in its August issue that compares the long-term results of spinal fusion surgery with those of cognitive intervention and exercise for patients with chronic lower back pain and disc degeneration. The study measures trunk muscle density, cross-sectional area, strength and patient-reported function at an average of 9 years post-treatment. The cognitive intervention and exercise program lasted three weeks, while the fusion was of either one or two lumbar levels.

Though the study featured a small sample size of 55, its results may be surprising to some; the three-week cognitive intervention and exercise training program yielded the same long-term benefits as the more complicated, expensive and risky back surgery. While most of the results were very similar, the group that had intervention and exercise treatment scored better on muscle flexion (ability to bend backward).

The trunk is composed of the torso, above the legs and below the head, excluding the arms. The muscles of the trunk are responsible for supporting and stabilizing the spine, balancing the body and allowing it to bend and rotate. Problems in the trunk area of the body can lead to chronic back pain. The strength and flexibility of its muscles are crucial to preventing and recovering from pain.

While the study shows fusion surgery to be as effective as more conservative methods, it must be noted that some people who have the procedure end up with more pain than before and require more surgeries. Also, having two vertebrae fused requires the removal of a spinal disc, which acted as a shock absorber. This removal places extra stress on the discs surrounding the fusion site and can lead to accelerated disc degeneration. Finally, the spine has less flexibility when its vertebrae are fused, which limits your ability to exercise and stretch.

Cognitive behavioral therapy is a psychophysical approach to back pain management. This type of therapy operates on the main tenet that thoughts and physical sensations have a reciprocal relationship. While pain can affect our thought process and our emotional state, our way of thinking can modulate our physical and emotional perception of pain.

Cognitive intervention is more a "mind with matter" than "mind over matter" approach to pain management. Practitioners acknowledge that pain is in the body as much as in the head, and altering one side of that equation will produce alterations in the other. Through education and mental technique training, cognitive intervention has proven successful in reducing patients' experience of pain. In-depth information on cognitive behavioral therapy can be found at http://www.nacbt.org/whatiscbt.htm.

Coupled with cognitive intervention, the exercise component of back pain therapy strengthens the muscles that support the spine, reducing pressure on worn or damaged spinal discs. Discs can often repair themselves if the load they bear is reduced.

Whereas back surgery comes with risk and a high price tag, conservative methods can be pursued without going broke or making your pain worse. As long as you consult a professional to guide you in exercise therapy, your treatment will be safe. Since pain is a whole-person experience, consider incorporating the mental aspect into your treatment plan. A well-rounded approach will likely yield more results than a one-sided approach.

An abstract of the above study can be viewed at http://www.thespinejournalonline.com/article/S1529-9430(11)00394-9/abstract.