Group Treatment for Chronic Low Back Pain: Theory, Practice and Effectiveness

Rehabilitation in musculoskeletal disorders through group treatment is commonly cited in literature, especially so in the last ten years, despite the fact that the contents and the characteristics of these programs are poorly documented. The aims of this chapter are: 1) to perform a narrative review on the cognitive behavioral approach and on group treatments for chronic low back pain (LBP), 2) to propose a "multimodal group program" model and to explain its application in different chronic spinal dysfunctions and diseases (disc degeneration, arthritis, spinal stenosis, anatmical and clinical instability, and 3) to show an example of this type of group treatment. Methods: A narrative review of literature was performed on the basis of current evidence. The "Multimodal group program" proposal was based on recent knowledge about the mechanical, neurophysiological, and behavioral components of chronic spinal pain. Finally, methods for the practical examples were the following: Sample: Six subjects with chronic low back pain (lasting at least three months). Treatment: ten weekly one-hour sessions. Outcome measures: Numerical Rating Scale (NRS), Oswestry Disability Index - Italian Version (ODI-I), Roland & Morris Disability Questionnaire (RMDQ), Tampa Scale for Kinesiophobia (TSK), and Short-Form Health Survey Quesionnaire (SF-36). Timing: Outcome measures were administered at baseline and at the end of the ten sessions. Discussion: The group treatment we proposed is defined as "multimodal" because during each meeting, a physical therapist incorporates some specific exercises with information and practical training on correct postures and movements. Moreover, explanation about the mechanisms for onset and persistence of pain and about the different strategies to manage it (through exercise, relaxation, and active coping strategies) is a fundamental part of the program. This group treatment includes different physical therapy strategies (joint mobilization, muscle strengthening, coordination and balance exercises, stretching, and so on) and a psychological approach, to modify beliefs and behaviors and to reduce the need for individual treatment.