Client-Centered Therapy vs Exercise Therapy for Chronic Low Back Pain: A Pilot Randomized Controlled Trial in Brazil

BACKGROUND: Psychological interventions targeting maladaptive pain behaviors and depressive symptoms are commonly used in the management of chronic pain. OBJECTIVE: To compare the effectiveness of psychotherapy, based on client-centered therapy, and exercise for patients with chronic nonspecific low back pain (LBP). SETTING: Outpatient physiotherapy and psychotherapy departments within a Brazilian academic institution. DESIGN: Thirty-three patients with chronic nonspecific LBP were recruited and randomized to receive client-centered therapy (N = 16) or exercise (N = 17) for 9 weeks. OUTCOME MEASURES AND DATA ANALYSIS: Pain and disability were measured at baseline, 9 weeks, and 6 months by a 10-cm visual analog scale and by the Brazilian Roland-Morris Questionnaire, respectively. Depression was measured at baseline and 9 weeks by the Beck Depression Inventory. Multiple regression analyses with baseline scores as covariates were used to determine the effects of treatment on outcomes. RESULTS: For all outcomes at each time point, the exercise group showed greater improvements than psychotherapy. The difference between groups was statistically and clinically significant for disability at 9 weeks (-4.9 points, 95% CI -9.08 to -0.72). CONCLUSIONS: This was the first study to investigate the effects of client-centered therapy and exercise for patients with chronic LBP. Our results showed that client-centered therapy is less effective than exercise in reducing disability at short term.