Strategies for combining interventional and behavioral therapies in management of chronic low back pain: A scoping review

Background: Common non-surgical treatment approaches for chronic low back pain (CLBP) include pharmacologic, interventional and behavioral therapies, but there is no consensus treatment approach. Despite studies that show the effectiveness of interventional and behavioral approaches individually and evidence-based recommendations for multimodal treatment approach, specific stacking and sequencing strategies used to combine both approaches haven't been studied. Objectives: The objectives of this scoping review were to: 1) explore how interventional and behavioral approaches to CLBP treatment are stacked or sequenced; 2) evaluate the feasibility of utilizing interventional and behavioral treatments in an integrative manner, and 3) assess whether optimal combinations of interventional and behavioral approaches to CLBP treatment exist. Methods: A literature search of indexed and gray literature was conducted for studies involving the combination of interventional and behavioral therapies for treatment of CLBP. 374 abstracts and 72 records of gray literature were independently screened followed by 60 that underwent full-text review. Results: A total of three studies were included in this review, all of which found the integration of modalities to be feasible. Two studies that utilized non-conventional interventions found no significant treatment effect by combining modalities. One study demonstrated a non-significant additive effect of combining radiofrequency ablation with cognitive behavioral therapy. Conclusions: Despite known individual benefits, there are limited studies exploring combined interventional and behavioral approaches to CLBP. Given the feasibility and the additive effects of combining interventions with behavioral therapy seen in the studies included this review, further exploration of this subject is needed to guide clinical practice.