Does the Use of Hydrotherapy and Behavioral Therapy in Addition to Pharmaceutical Medicine Reduce Chronic Back Pain in Adults?

Background: Chronic back pain (CBP) is a debilitating condition affecting millions worldwide, significantly impairing physical function, reducing quality of life, and imposing substantial healthcare costs. CBP is traditionally managed with pharmacological treatments, including opioids, acetaminophen, and nonsteroidal anti-inflammatory drugs (NSAIDs) which are often supplemented by prescribed physical activity to alleviate pain and improve quality of life. Recently, alternative therapies such as hydrotherapy and behavioral interventions have become more popular as safe and effective approaches to improving pain management in CBP patients. This integrative review aims to provide valuable insights into pain management, supporting healthcare professionals in developing more effective holistic treatment approaches for individuals with chronic back pain while also addressing whether incorporating hydrotherapy and behavioral therapy with pharmaceutical treatments effectively reduces pain in adults with CBP. Methods: Literature search was completed using CINAHL, OVID, PubMed, Medline, and Cochrane databases for an integrative review. The integrative review process was guided by Whittmore and Knafl’s five-stage framework and utilized the organizational tool from Johns Hopkins Nursing Evidence-Based Practice Model (JHNEBP). A comprehensive search was conducted, identifying studies published between 2014 and 2024 using predetermined inclusion criteria, exclusion criteria, and search terms. Data was then screened ant outlined in a PRISMA flowchart. The data was then summarized into a chart matrix. Results: The literature revealed three key themes regarding the use of hydrotherapy or cognitive-based therapy alongside pharmaceuticals for threating CBP; (1) enhanced outcomes with combined and multimodal treatments; (2) patient education; and (3) collaborative patient-centered approach. Alongside these themes, it was concluded that hydrotherapy and behavioral interventions provided reductions in pain and improvements in quality of life. Conclusion: Multimodal approaches showed improvements in pain reduction and quality of life. Integrating both pharmaceutical and non-pharmaceutical therapies addresses the complexities of CBP more effectively than relying on medications alone. The findings provide insight on effectiveness of multimodal and integrated treatment approaches.