According to a large new study involving over 13,000 patients, the optimal treatments for persistent back pain should include both physical and mental factors, rather than focusing simply on physical treatments.Researchers discovered that adding psychological interventions to treatments - primarily behavioral therapy and pain education - resulted in the most long-term benefits for both physical function and pain intensity, based on a systematic review of 97 previous trials covering 17 different approaches to treating chronic back pain.

"Clinical guidelines consistently recommend a combination of exercise and psychosocial therapies for managing chronic low back pain," physiotherapist Emma Ho from the University of Sydney in Australia, said.

"However very little is actually known about the different types of psychological therapies available and their effectiveness."

As a result, according to Ho, doctors and patients alike are frequently unclear about the appropriate course of treatment. One of the reasons for the current study was to provide some light on what is accessible and what works best.

For the statistical analysis of the study, six major categories of psychological interventions were identified: behavioral interventions, cognitive behavioral therapies, mindfulness, counseling, and pain educational programs. The sixth type of trial used the combination of two or more psychological techniques.

Both cognitive behavioral therapy and pain education with physiotherapy were more effective than physiotherapy alone in increasing physical function. Behavioral therapy, cognitive behavioral therapy, and pain education have all been demonstrated to be helpful treatments for reducing pain severity.

However, the effectiveness of the studies altered with time, and separate trials ran for varying lengths of time. Over the course of six and twelve months after treatment, pain education and behavioral therapy were found to have the most impact. These therapies also appear to be safe based on the existing data.

Aside from physical function and pain intensity, the team looked at health-related quality of life, safety, treatment compliance, and fear avoidance - that is, delaying activity due to dread of pain. Treatments that included additional psychological measures yielded superior results once again.

There are some limitations to the study that should be discussed: the researchers state that the long-term effectiveness of these treatments (beyond 12 months) has to be evaluated, and some of the trials utilized in the analysis had poor quality safety reporting data.

However, when taken as a whole, the new study provides valuable insights into which psychological therapies perform best and how much more effective supplementary treatments can be overall as compared to depending simply on physical treatments and exercises.

"Clinicians should consider incorporating psychological interventions with physiotherapy care (mainly structured exercise) to maximize improvements in health outcomes," the researchers wrote.

The research has been published in the BMJ.