Stress is dominant in patients with depression and chronic low back pain. A qualitative study of psychotherapeutic interventions for patients with non-specific low back pain of 3–12 months’ duration

Abstract

BackgroundThere is continuing uncertainty in back pain research as to which treatment is best suited to patients with non-specific chronic low back pain (CLBP). In this study, Gestalt therapy and the shock trauma method Somatic Experiencing® (SE) were used as interventions in parallel with the usual cross-disciplinary approach. The aim was to investigate how these treatments influence a patient’s capacity to cope with CLBP when it is coupled with depression.MethodsIn this qualitative explorative study, a phenomenological–hermeneutic framework was adopted. Patients were recruited on the basis of following criteria: A moderate depression score of 23–30 according to the Beck Depression Inventory Scale and a pain score of 7–10 (Box scale from 0–10) and attendance at five- six psychotherapeutic sessions. Six patients participated in the study. The data was comprised of written field notes from each session, which were subsequently analysed and interpreted at three levels: naive reading, structural analysis and critical interpretation and discussion.ResultsThree areas of focus emerged: the significance of previous experiences, restrictions in everyday life and restoration of inner resources during the therapy period. The study revealed a diversity of psychological stressors that related to loss and sorrow, being let down, violations, traumatic events and reduced functioning, which led to displays of distress, powerlessness, reduced self-worth, anxiety and discomfort.Overall, the sum of the stressors together with pain and depression were shown to trigger stress symptoms. Stress was down-played in the psychotherapeutic treatment and inner resources were re-established, which manifested as increased relaxation, presence, self-worth, sense of responsibility and happiness. This, in turn, assisted the patients to better manage their CLBP.ConclusionsCLBP is a stress factor in itself but when coupled with depression, they can be regarded as two symptom complexes that mutually affect each other in negative ways. When pain, stress and depression become overwhelming and there are few internal resources available, stress seems to become prominent. In this study, Gestalt therapy and the SE-method may have helped to lower the six patients’ level of stress and restore their own internal resources, thereby increasing their capacity to cope with their CLBP.

Mediators and Moderators of Chronic Pain Outcomes in an Online Self-Management Program

“…In this analysis, stress mediated the relationship between painACTION.com intervention and pain severity. The link between pain and stress has long been supported in the literature, 48,49 to the extent that cognitive-behavioral stress-management has been used as a treatment for chronic tension-type headaches. 22 Although not statistically significant, a similar trend was noted for depression.…”

Risk Factors for Low Back Pain and Spine Surgery

“…Tobacco use, 16,17 alcohol use, 18,19 obesity, 20 sleep disturbances, [21][22][23] and mental health disorders 2, [24][25][26] have been identified as risk factors for LBP. Furthermore, people with LBP and medical comorbidities of nicotine dependence, 27 psychological disorders, 24,[26][27][28] sleep disturbance, 29 or alcohol use 18 have shown increased risk for LBP becoming chronic or debilitating. These comorbid medical conditions are usually examined in isolation among subsets of the population as factors associated with LBP; therefore, a multifactorial investigation in a large cohort is lacking.…”

Psychological Response to Hospitalization Stress in Patints in Orthopedic-Traumatological Hospital

“…Учитывая длительные сроки лечения у многих пациентов травматолого-ортопедического профиля, целесообразно применять психотерапевтическое лечение для повышения темпов их реабилитации. Важность своевременного выявления пациентов с повышенным уровнем тревожности и проведение соответствующей психологической коррекции подчеркивается практически в каждой работе, посвященной этой проблеме [12,13,19]. Согласно полученным в исследовании выводам о психологических особенностях данной выборки пациентов, оптимальным методом психокоррекционной работы с ними является сочетание гештальттерапии с адлерианским подходом.…”