COGNITIVE BEHAVIOURAL THERAPY AS AN IMPORTANT COMPONENT OF A MULTIDISCIPLINARY REHABILITATION PROGRAMME FOR PATIENTS WITH CHRONIC LOWER BACK PAIN
DOI:
https://doi.org/10.32782/3041-2005/2026-1.24Keywords:
chronic pain, chronic low back pain, cognitive behavioural therapy, multidisciplinary rehabilitation, biopsychosocial model, psychotherapyAbstract
Chronic low back pain (CLBP) is one of the leading causes of disability and reduced quality of life worldwide. Current understanding of the pathogenesis of CLBP is based on a biopsychosocial model, according to which psychoemotional and cognitive-behavioral factors play a key role in the development of chronic pain syndrome and associated functional limitations. Psychological interventions play a leading role in the management of chronic low back pain and, in combination with physical exercise, demonstrate higher efficacy compared to the isolated use of individual therapeutic approaches. The development of algorithms and the integration of cognitive behavioral therapy (CBT) into multidisciplinary rehabilitation programs is of great clinical importance and requires further study. Objective. To justify and develop an algorithm of cognitive-behavioural therapy for patients with chronic lower back pain, integrated into a multidisciplinary rehabilitation programme. Materials and methods. A systematic analysis, generalisation and comparative assessment of current scientific sources devoted to the theoretical foundations, methodological approaches and clinical experience of using CBT for chronic pain was conducted. Results. Analysis of the literature confirmed that CBT is a proven effective component of multidisciplinary rehabilitation of patients with CLBP and is recommended by international clinical guidelines, especially in the presence of psychosocial risk factors for chronic pain. The developed algorithm for integrating CBT, which involves a step-by-step biopsychosocial assessment, stratification of patients according to their level of psychosocial risk, and a differentiated choice of intensity and format of cognitive-behavioural interventions, aims to improve the recovery of functioning and quality of life of patients with CLBP. Conclusions. The proposed algorithm for the application of CBT in multidisciplinary rehabilitation programmes for patients with CLBP provides a personalised approach to treatment, contributes to reducing disability, improving functioning and social participation of patients, and can be recommended for implementation in outpatient rehabilitation practice.
References
Krismer M., van Tulder M. Low Back Pain Group of the Bone and Joint Health Strategies for Europe Project. Strategies for prevention and management of musculoskeletal conditions. Low back pain (non-specific). Best Practice & Research. Clinical Rheumatology. 2007. Vol. 21. № 1. P. 77–91. DOI: 10.1016/j.berh.2006.08.004
GBD 2021 Low Back Pain Collaborators. Global, regional, and national burden of low back pain, 1990–2020, its attributable risk factors, and projections to 2050: a systematic analysis of the Global Burden of Disease Study 2021. The Lancet. Rheumatology. 2023. Vol. 5. № 6. P. e316 – e329. DOI: 10.1016/S2665-9913(23)00098-X
Farley T., Stokke J., Goyal K., DeMicco R. Chronic low back pain: history, symptoms, pain mechanisms, and treatment. Life (Basel). 2024. Vol. 14. № 7. Art. 812. DOI: 10.3390/life14070812
Ovdii M., Korshak V. Chronic lower back pain: a look at the problem from the perspective of the biopsychosocial model: an analytical review of scientific literature. Ukraine. Health of the Nation. 2025. № 1. P. 134–138. DOI: 10.32782/2077-6594/2025.1/23
Leung T., Low M.K., Yao P.C., Pinho-Gomes A.C. The effect of cognitive behavioural therapy on pain and disability in chronic non-specific low back pain: an overview of systematic reviews. PLoS One. 2025. Vol. 20. № 6. Art. e0325122. DOI: 10.1371/journal.pone.0325122
Sanabria-Mazo J.P., Colomer-Carbonell A., Fernández-Vázquez Ó., Noboa-Rocamora G., Cardona-Ros G., McCracken L.M., Montes-Pérez A., Castaño-Asins J.R., Edo S., Borràs X., Sanz A., Feliu-Soler A., Luciano J.V. A systematic review of cognitive behavioral therapy-based interventions for comorbid chronic pain and clinically relevant psychological distress. Frontiers in Psychology. 2023. Vol. 14. Art. 1200685. DOI: 10.3389/fpsyg.2023.1200685
Ovdii M., Yaremenko L., Lyvatskyi O., Lyvatska S., Sipakova D. Psychoemotional factors as predictors of chronic non-specific low back pain. Proceedings of the Shevchenko Scientific Society. Medical Sciences. 2025. Vol. 77. № 2. DOI: 10.25040/ntsh2025.02.14
Airaksinen O., Brox J.I., Cedraschi C., Hildebrandt J., Klaber-Moffett J., Kovacs F., Mannion A.F., Reis S., Staal J.B., Ursin H., Zanoli G. COST B13 Working Group. European guidelines for the management of chronic nonspecific low back pain. Chapter 4. European Spine Journal. 2006. Vol. 15. Suppl. 2. P. S192 – S300. DOI: 10.1007/s00586-006-1072-1
O’Sullivan K. Appraisal of clinical practice guideline: World Health Organization guideline for non-surgical management of chronic primary low back pain. Journal of Physiotherapy. 2024. Vol. 70. № 2. P. 156. DOI: 10.1016/j.jphys.2024.02.008
Carville S., Constanti M., Kosky N., Stannard C., Wilkinson C. Chronic pain (primary and secondary) in over 16s: summary of NICE guidance. BMJ. 2021. Art. n895. DOI: 10.1136/bmj.n895
Chou R., Qaseem A., Snow V. та ін. Diagnosis and treatment of low back pain: a joint clinical practice guideline. Annals of Internal Medicine. 2007. Vol. 147, No. 7. P. 478–491. DOI: https://doi.org/10.7326/0003-4819-147-7-200710020-00006.
Chou R., Qaseem A., Snow V., Casey D., Cross J.T., Shekelle P., Owens D.K. Low back pain. Journal of Orthopaedic and Sports Physical Therapy. 2012. Vol. 42. № 4. P. A1 – A57. DOI: 10.2519/jospt.2012.42.4.A1
Monticone M., Ferrante S., Rocca B., Baiardi P., Dal Farra F., Foti C. Effect of a long-lasting multidisciplinary program on disability and fear-avoidance behaviors. The Clinical Journal of Pain. 2013. Vol. 29. № 11. P. 929–938. DOI: 10.1097/AJP.0B013E31827FEF7E
O’Keeffe M., O’Sullivan P., Purtill H., Bargary N., O’Sullivan K. Cognitive functional therapy compared with group-based exercise and education. British Journal of Sports Medicine. 2020. Vol. 54. № 13. P. 782–789. DOI: 10.1136/bjsports-2019-100780
Zhang Q., Xu H., Wang Y., Jiang J., Xue Q., Qiu Z. Efficacy of cognitive behavioral therapy for chronic low back pain: a systematic review and meta-analysis. Medicine. 2023. Vol. 102. Art. e35269. DOI: 10.1097/MD.0000000000035269
Greenberger D., Padesky C.A. Mind over mood: a cognitive therapy treatment manual for clients. New York : Guilford Press, 1995. 241 p.
Vlaeyen J.W., Haazen I.W., Schuerman J.A., Kole-Snijders A.M., van Eek H. Behavioural rehabilitation of chronic low back pain. British Journal of Clinical Psychology. 1995. Vol. 34. № 1. P. 95–118. DOI: 10.1111/j.2044-8260.1995.tb01443.x
Wall & Melzack’s textbook of pain / S.B. McMahon, M. Koltzenburg, I. Tracey, D.C. Turk (Ed.). Philadelphia : Elsevier Health Sciences, 2013. 1184 p.
Овдій М., Федьков Д., Русанов В., Михайличенко М., Терещенко Н. Обґрунтування діагностичного алгоритму для пацієнтів із хронічним болем у нижній ділянці спини. Сучасна медицина, фармація та психологічне здоров’я. 2025. Вип. 2 (20). С. 82–92.
Hayes S.C. Cognitive behavior therapy. Handbook of cognitive behavior therapy / W.T. O’Donohue, J.E. Fisher (Ed.). Chichester : Wiley, 2012. 318 p.
Henschke N., Ostelo R.W., van Tulder M.W., Vlaeyen J.W., Morley S., Assendelft W.J., Main C.J. Behavioural treatment for chronic low-back pain. Cochrane Database of Systematic Reviews. 2010. № 7. Art. CD002014. DOI: 10.1002/14651858.CD002014.pub3
Fritz J.M., Rhon D.I., Teyhen D.S., Kean J., Vanneman M.E., Garland E.L., Lee I.E., Thorp R.E., Greene T.H. A sequential multiple-assignment randomized trial (SMART) for stepped care management of low back pain. Pain Medicine. 2020. Vol. 21. Suppl. 2. P. S73 – S82. DOI: 10.1093/pm/pnaa338
Gatzounis R., Schrooten M.G., Crombez G., Vlaeyen J.W. Operant learning theory in pain and chronic pain rehabilitation. Current Pain and Headache Reports. 2012. Vol. 16. № 2. P. 117–126. DOI: 10.1007/s11916-012-0247-1
Sullivan M.J. Toward a biopsychomotor conceptualization of pain. The Clinical Journal of Pain. 2008. Vol. 24. № 4. P. 281–290. DOI: 10.1097/AJP.0b013e318164bb15
Turner J.A., Jensen M.P. Efficacy of cognitive therapy for chronic low back pain. Pain. 1993. Vol. 52. № 2. P. 169–177. DOI: 10.1016/0304-3959(93)90128-C
Geetanjali G., Wahane A., Sharma A. Exploring effective strategies for stress management. Bulletin of Environmental Pharmacology and Life Sciences. 2023. Vol. 12. № 5. P. 345–348.
Sielski R., Rief W., Glombiewski J. A. Efficacy of biofeedback in chronic back pain: a meta-analysis. International Journal of Behavioral Medicine. 2017. Vol. 24. № 1. P. 25–41.
