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In patients with persistent nonspecific low back pain, physical treatments (e.g., manipulation, acupuncture) or simple advice to remain active yields only modest, short-term benefits compared with usual care. Cognitive behavioral interventions (CBIs) have shown some benefit but have not been tested in adequately powered trials lasting more than 6 months.
In a randomized trial involving 56 British general practices, 701 adults (average age, 54) with at least moderate low back pain for ≥6 weeks (and without “red flags” for serious disease) received 15 minutes of advice about active management and a book on back pain; 468 also were assigned to receive a CBI that consisted of an individual assessment and three to six group sessions focusing on p…