April 21, 2026 — For millions of people living with chronic lower back pain, deciding where to start treatment can be overwhelming. A new large-scale study from Spain offers clarity: physical therapy may be a reasonable first step, but switching therapies or adding psychological support later may not significantly improve outcomes.
The research, published by Infosalus and based on a comprehensive analysis of chronic low back pain management, suggests that while physiotherapy can serve as an appropriate initial intervention, changing course or combining treatments afterward does not appear to alter the overall trajectory of pain reduction or functional improvement.
Chronic lower back pain, defined as discomfort lasting three months or longer, is recognized by the International Association for the Study of Pain as a biopsychosocial condition. Which means the experience of pain is shaped not only by physical factors but similarly by psychological and social influences, including stress, anxiety, depression, and catastrophizing thoughts about pain.
Experts note that the brain plays a central role in modulating pain intensity, frequency, and duration. Psychological contributors — such as work-related stress, poor sleep, or interpersonal tensions — can amplify physical discomfort, while living with persistent pain often increases the risk of mental health challenges, creating a self-reinforcing cycle that can be difficult to break.
Although psychological therapies have shown promise in addressing the emotional and cognitive dimensions of chronic pain, this particular study indicates that introducing them after an initial course of physical therapy may not yield additional benefits in terms of pain intensity or interference with daily life.
The findings highlight the complexity of managing chronic musculoskeletal conditions and underscore the importance of early, evidence-based interventions. For patients and clinicians navigating treatment options, the study supports considering physical therapy as a foundational approach, while reminding that individual responses vary and comprehensive care should still address both physical and psychological aspects of pain.
