The spectacular role of therapeutic alliance in modulating pain intensity and pain sensitivity in chronic low back pain
Canada is a beautiful country, with friendly people and top-level pain researchers.
A new study from the University of Alberta has provided compelling experimental evidence
for the role of therapeutic alliance in the treatment of chronic low back pain (Fuentes et al. 2014).
Therapeutic alliance is an important contextual or non-specific treatment factor that can be defined as the (positive) social connection
between the patient and the therapist. It involves more than communication, and includes warmth, the sense of collaboration, empathy and support.
Previous studies have shown that therapeutic alliance is an important determinant of treatment adherence and treatment outcome.
This new Canadian study adds to this by providing evidence for a cause-and-effect relationship between therapeutic alliance and treatment outcome
following interferential current therapy in patients with chronic low back pain. It was shown that enhanced therapeutic alliance dramatically improves
the therapeutic effects in terms of pain intensity and pain sensitivity in patients with chronic low back pain.
How can we, as clinicians, improve the therapeutic alliance with our patients? Here is how the researchers have done it in this trial:
they questioned the patients about their symptoms, lifestyle and (presumed) cause of their condition (i.e. illness perceptions were questioned);
they focussed on verbal behaviours, including active listening, tone of voice, nonverbal behaviours, and empathy;
the therapist stayed in the treatment room during the entire treatment and during this time verbal interaction with the patient was encouraged;
at the end of the session, few words of encouragement were given.
Physical Therapy 2014 Apr;94(4):477-89. Enhanced therapeutic alliance modulates pain intensity and muscle pain sensitivity in patients with chronic
low back pain: an experimental controlled study.