My brother hurt his back at work and has not had a very good recovery. He’s seeing a behavioral counselor who seems to give him a good rah-rah session but no practical suggestions about diet, exercise, and a common sense approach to getting better. Am I off base here thinking this is a waste of time and money?

There is some evidence that psychosocial factors are part of the reason patients develop chronic pain that ends in disability. It seems that the subacute phase is when these influences have their greatest effect. Psychosocial variables refer to beliefs, moods, and coping. The subacute period of time is usuallybetween six and 12 weeks after the injury.

Behavioral medicine is a model that puts the focus on self-management of pain, slowly increasing activity, reducing fear of movement or reinjury, and changing beliefs about pain. Anatomy of the spine and physiologic function are reviewed to help patients understand their back pain.

Patients are usually given exercises and activities to complete at home. Vocational counseling and stress management are offered to those who need it. The role of attitude, emotions, and interpersonal relationships as these relate to back pain are discussed.

A different approach to back pain is called attention control condition. It sounds like this may be the type of therapy your brother is receiving. Patients receive empathy, support, and assurance from counselors who listen to them. They are encouraged to go back to the orthopedic physician or physical therapist whenever they needed help to manage their pain and speed up recovery.

There aren’t very many studies comparing these two methods. But a small pilot study from the San Diego Naval Medical Center recently published their results. Their patients were young, otherwise healthy men who had experienced their first bout of low back pain.

Recovery rates were three times higher in the behavioral medicine group than in the attention control group. More patients in the behavioral medicine group recovered at six months and were back to work full-time at their pre-back pain level of activity. Test results showed that patients in the behavioral medicine group also changed their attitudes about seeing pain as disabling.

The authors say that although this was a small study limited to military personnel, the results suggest that a behavioral approach may be a very useful way to move patients with subacute back pain toward recovery. Preventing chronic back pain from developing saves money but also saves people from suffering unnecessarily. Empathy and therapist support may be a feel good approach. But it appears that directive treatment guiding patients through rehab has better results.