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.

Publisher: BioMed Central Country of Publication: England NLM ID: 100968565 Publication Model: Electronic Cited Medium: Internet ISSN: 1471-2474 (Electronic) Linking ISSN: 14712474 NLM ISO Abbreviation: BMC Musculoskelet Disord Subsets: MEDLINE

Original Publication: London : BioMed Central, [2000-

Gestalt Therapy* ; Psychiatric Somatic Therapies*; Chronic Pain/*therapy ; Depression/*therapy ; Low Back Pain/*therapy ; Stress, Psychological/*therapy; Adaptation, Psychological ; Adult ; Chronic Pain/diagnosis ; Chronic Pain/epidemiology ; Cost of Illness ; Denmark/epidemiology ; Depression/diagnosis ; Depression/epidemiology ; Emotions ; Female ; Humans ; Life Change Events ; Low Back Pain/diagnosis ; Low Back Pain/epidemiology ; Male ; Pain Measurement ; Psychiatric Status Rating Scales ; Qualitative Research ; Stress, Psychological/diagnosis ; Stress, Psychological/epidemiology ; Time Factors ; Treatment Outcome ; Young Adult

Background: There 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.
Methods: In 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.
Results: Three 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.
Conclusions: CLBP 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.

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Date Created: 20120907 Date Completed: 20130312 Latest Revision: 20211021

20231215

PMC3495206

10.1186/1471-2474-13-166

22950571