Effect of Cognitive Behavioral Therapy on Chronic Low Back Pain With Sensitization
Condition: Chronic Low Back Pain; Central Sensitisation
MeSH terms: Back Pain; Low Back Pain
Study type: Interventional

Summary: 
      PURPOSE:

      The main objectives of the study are:

        1. To find the efficacy of using cognitive behavioural therapy on chronic low back pain
           with central sensitization.

        2. To assist in planning an ideal physical therapy rehabilitation program for these
           patients.

      BACKGROUND:

      Recent research has shown that CLBP is a multifactorial disorder comprising psychosocial
      factors like pain catastrophization, fear avoidance and central sensitization. Central
      sensitization has been defined as "An amplification of neural signaling within the central
      nervous system that elicits pain hypersensitivity", and "increased responsiveness of
      nociceptive neurons in the central nervous system to their normal or subthreshold afferent
      input".

      Maladaptive behavior, false beliefs and misinformation regarding the cause of the pain are
      all contributing factors to the chronicity of LBP.

      Central sensitization has been attributed to cortical reorganization and amplification of the
      somatosensory representation of the back causing increased pain and further contributing to
      the maladaptive behavior and beliefs.

      Cognitive behavioral treatment has been an important intervention for psychological disorders
      for decades and recently has gained a lot of interest as an intervention for chronic pain in
      general and CLBP in specific.

      HYPOTHESES:

      It will be hypothesized that: Cognitive behavioural therapy will have a significant effect on
      centrally sensitized pain intensity and disability.

      RESEARCH QUESTION:" Does cognitive behavioral therapy have a significant effect on chronic
      low back pain with central sensitization"
    


Intervention name(s): Cognitive Behavioural Therapy; Strengthening exercises
Intervention type(s): Behavioral; Other
Intervention description(s): Following assessment a one on one session will be given comprising education cognitively targeting false ideas and beliefs on the nature of pain, differentiating nociception due to a painful stimulus and the transition of such a stimulus to a centrally sensitized experience due to misinformation, maladaptive behaviour and fear avoidance. Upon completion of the session assessment using the NPQ will be done to assess the understanding of the patient and further address any shortcomings in future exercise sessions.
Another SEMG recording of the Flexion Relaxation phenomenon will be upon completion of the educational session and a SEMG biofeedback session will begin to help the patient regain their sense of control over their body and function.
After the SEMG biofeedback session a graded exposure exercise program of strengthening and functional training starting from the least feared movements to the most over 10 sessions over 5 weeks.; Strengthening exercises in a gradual manner to the Multifidus and Transversus Abdominis muscles.
Other intervention name(s): SEMG Biofeedback
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Single (Participant)
Primary purpose: Treatment
Keywords: Cognitive Behavioural Therapy; Flexion Relaxation Phenomenon; Electromyography; Biofeedback; Functional Training