Combining procedural and behavioral treatments for chronic low back pain: A pilot feasibility randomized controlled trial.

Only 13 people were randomised, all of them men, from a single Veterans Affairs pain clinic, and the study was never designed to test whether these treatments work. The groups were not well balanced at the start: 43% of the video CBT group were Hispanic or Latino compared with none of the telephone group, and several groups differed in how disabled they were at baseline. No sample size calculation was done, and only age and baseline scores could be adjusted for, so other differences between the groups are simply unaccounted for. One man with pain on both sides of his back had ablation on one side only, which the authors say could push the ablation result towards showing no effect; some CBT sessions were still unfinished at the three-month assessment, which could do the same for the talking treatment. The check on whether people knew which procedure they had was made a month afterwards, so those who felt better tended to assume they had the real thing; the doctors performing the procedures were never checked at all. Recruitment stopped early because of the COVID-19 pandemic.

The conflict of interest statement says one author, Dr. Kim, received payment for a one-time consultation and for expert testimony about upper extremity pain, paid directly to the author; the remaining authors declared no conflicts of interest. No funding source appears in the text supplied.

Do not take the 6.3-point advantage for video CBT as proof that video-based CBT works better than a book and a phone call for chronic low back pain. It comes from 13 men in a feasibility study with no sample size calculation, the two talking-treatment groups differed in ethnicity, and the psychologists delivering the sessions knew which treatment they were giving. This trial was built to ask whether the study could be run, not whether the treatment works.