999 - Strategies for Combining Interventional and Behavioral Therapies in Management of Chronic Low Back Pain: A Scoping Review

Objectives: The objectives of this scoping review were to1) explore how interventional and behavioral approaches to the treatment of low back pain are stacked or sequenced in attempt to optimize pain control 2) evaluate the feasibility of utilizing interventional and behavioral treatments in an integrative manner to treating low back pain and 3) assess whether optimal combinations of interventional and behavioral approaches to the treatment of low back pain exist and can be further studied.

Design: A literature search of PubMed, The Cochrane Library and gray literature was conducted for RCT, case-control and observational studies involving the combination of interventional and behavioral therapies for treatment of adults with chronic low back pain. three hundred and seventy four abstracts and seventy two records of gray literature were independently screened by two screeners and conflicts were resolved by a third independent screener. The records that passed the abstract screening process underwent full-text review.

Results: A total of three studies were included in this review.  All three studies found the integration of modalities to be feasible. Two studies that utilized non-conventional interventions found no significant difference in combining modalities. One study demonstrated a non-significant additive effect of combining radiofrequency ablation with cognitive behavioral therapy,

Conclusions: Despite the known benefits of interventional and non-pharmacologic behavioral approaches to treatment of chronic low back pain separately, there are limited studies exploring their combination. Given the feasibility found in the studies in this review and the additive effects seen in the study that utilized conventional interventions with behavioral therapy, further exploration of this subject is needed to guide clinical practice.