OBJECTIVE Stress management in patients with chronic low back (CLBP) pain has not been studied systematically. After the age of 30 years, about 80% of people will have a low back pain crisis, immobilizing them from a few to many days. Each year more man-hours are lost due to CLBP than any other condition and 25% of the patients visiting the orthopedic outpatients clinics suffer from low back pain. METHOD This trial included patients, in random order, who visited the Outpatients Clinics of the Orthopedic Department in "Andreas Papandreou" General Hospital, Rhodes, Greece, in the Second Administrative Health Region of the South Aegean, with low back pain. They participated in this randomized clinical trial (RCT) voluntarily after giving their written informed consent. Stress management techniques, including diaphragmatic breathing, progressive muscle relaxation, guided visualization and autogenic training were implemented in the intervention group (n = 30). The follow-up was 8 weeks. Self-reported validated measurements of stress assessment were used aimed at valuating the perceived stress, lifestyle modifications and pain. The intervention group filled in a daily log of implementation of the relaxation techniques. The follow-up was 8 weeks. RESULTS The percentage of people reporting that they feel extra pain on the day of filling in the questionnaire was lower at the end (10.0%) than at the start of the trial (23.3%, p < 0.001). In the intervention group, an increase was observed in the routine scores in total and specifically increases were observed in the scores of the SF-36 questionnaire on quality of life (higher values show better condition) and, in particular, for physical functionality. An overall decrease was observed in the reported stress level, perceived stress (PSS-14), the total score of symptoms and the "chance" health control center. CONCLUSIONS It is imperative to carry out further such studies, incorporated in more objective laboratory trials. Trials need to be carried out extending these first conclusions on the favorable effects of stress control on CLBP and examining other similar techniques, with more objective measurement of the stress levels, using biomarkers.

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