Biofeedback, Relaxation Training and Cognitive Therapy May Be Effective Substitutes
for or Adjuncts to Medical Treatments

WASHINGTON -- Americans spend billions of dollars a year on often-unsuccessful attempts to relieve chronic head or lower back pain. Low back pain is second only to upper respiratory symptoms in causing medical office visits. While most people treat most headaches with over-the-counter medications, there are some for whom neither those drugs nor more potent prescription medications are effective (or tolerable). But according to two articles in the December issue of Professional Psychology: Research and Practice, published by the American Psychological Association (APA), there are effective psychological interventions for both conditions.

In "Psychological Treatment of Benign Headache Disorders," Edward B. Blanchard, Ph.D., of the University at Albany, State University of New York and Seymour Diamond, MD, of the Diamond Headache Clinic in Chicago, write that there is now a sizable body of research literature supporting three broad classes of psychological treatments for headache: biofeedback training, varieties of relaxation training and certain specific forms of cognitive therapy. While psychological interventions don't work as quickly as medications -- and not all headache sufferers respond to them -- they can produce long-lasting (up to five years) relief.

Psychological interventions for headache appear to be especially effective for younger patients, the authors note. Several studies have shown greater improvement has been seen in patients 21 and under than in adults over 45.

The authors say that, unlike medications whose side effects can include drug dependency, the only negative side effect of psychological interventions that has been seen is ineffectiveness, that is, the headache didn't go away. On the other hand, several studies have found that even when psychological interventions are unsuccessful at relieving head pain, they can significantly reduce depression and anxiety in headache sufferers.

The situation with chronic lower back pain is more complicated. In "Psychophysiologic Treatment of Chronic Lower Back Pain," authors Richard N. Gevirtz, Ph.D., of the California School of Professional Psychology and David R. Hubbard, MD, and R. Edward Harpin, Ph.D., of the Sharp Pain Rehabilitation Program in San Diego note that "chronic lower back pain is one of the most prevalent yet poorly treated health problems in Western society" and is "neither well understood or treated effectively using medical or surgical techniques."

Meanwhile, the authors say, the research on purely psychological approaches to treating chronic lower back pain has sometimes reached contradictory conclusions, but, they note, "overall, there seems to be a consensus that psychological interventions [such as relaxation training, biofeedback and cognitive and behavioral therapy] are usually efficacious."

Instead of either a purely physical or purely psychological approach to treating chronic lower back pain, the authors propose a psychophysiological model which combines elements of both. They describe an interdisciplinary treatment program in which patients are educated in anatomy and physiology, trained (via biofeedback) in muscle tension awareness, taught to identify the stressors in their daily lives that lead to activation of the muscle tension response and then to take steps to "disarm" those stressors.

The authors conclude that although there is still much to be learned about what causes chronic lower back pain and how best to treat it, viewing it and treating it as both a medical and a psychological disorder may provide better results for people who have it.

5/30/98

Reference: "Psychophysiologic Treatment of Chronic Lower Back Pain," by Richard N. Gevirtz, Ph.D., California School of Professional Psychology and David R. Hubbard, MD, and R. Edward Harpin, Ph.D., Sharp Pain Rehabilitation Institute, San Diego, in Professional Psychology: Research and Practice, Vol. 27, No. 6.

The American Psychological Association (APA), in Washington, DC, is the largest scientific and professional organization representing psychology in the United States and is the world's largest association of psychologists. APA's membership includes more than 159,000 researchers, educators, clinicians, consultants and students. Through its divisions in 50 subfields of psychology and affiliations with 58 state, territorial and Canadian provincial associations, APA works to advance psychology as a science, as a profession and as a means of promoting human welfare.