A new study is encouraging a radical step away from the traditional way we treat chronic back pain.
Researchers at UNSW Sydney and Neuroscience Research Australia (NeuRA) say we should no longer look at chronic back as a disc, bone or muscle problem, instead recasting it as a modifiable problem of the nervous system.
This idea does away with drugs and treatments that focus on the back such as spinal manipulation, injections, surgery and spinal cord stimulators.
Just about anyone who has chronic back pain will complain that those treatments offer short-term relief at best, and do little to fix the attendant disability.
The new treatment focuses on retraining how the back and the brain communicate – and has been shown to bring clinically meaningful benefits in a 12-week randomised controlled trial.
The study is described in a paper published in the Journal of the American Medical Association.
What happened in the study?
According to an explainer from NeuRA, the study divided 276 participants into two groups: One undertook a 12-week course of sensorimotor retraining and the other received a 12-week course of ‘‘sham treatments’’ designed to control for placebo effects, which are common in low back pain trials.
The sham treatments included mock laser therapy and non-invasive brain stimulation.
Professor James McAuley from UNSW’s School of Health Sciences, and NeuRA said that sensorimotor retraining alters how people think about their body in pain, how they process sensory information from their back, and how they move their back during activities.
‘‘What we observed in our trial was a clinically meaningful effect on pain intensity and a clinically meaningful effect on disability. People were happier, they reported their backs felt better and their quality of life was better,’’ he said.
Few treatments for low back pain show long-term benefits, but participants in the trial reported improved quality of life one year later.
Professor McAuley said that in studies that compared opioid treatment to a placebo, the difference between the two tended to be ‘‘less than one point out of 10 in pain intensity’’.
In other words, opiates delivered marginally better pain relief than a sugar pill.
‘‘We see similar results for studies comparing manual therapy to sham or exercise to sham,’’ he said.
Although the study delivered better results than those gained by opiates, the pain relief from the new treatment was modest. This may be due to the need for retraining to continue in the longer term.
How it works
The treatment is based on research that showed the nervous system of people suffering from chronic back pain behaves in a different way from people who have a recent injury to the lower back.
“People with back pain are often told their back is vulnerable and needs protecting,’’ Professor McAuley said.
‘‘This changes how we filter and interpret information from our back and how we move our back.
‘‘Over time, the back becomes less fit, and the way the back and brain communicate is disrupted in ways that seem to reinforce the notion that the back is vulnerable and needs protecting.’’
The new treatment ‘‘aims to break this self-sustaining cycle”.
The treatment aims to achieve three goals:
- To align patient understanding with the latest scientific understanding about what causes chronic back pain
- To normalise the way the back and the brain communicate with each other
- To gradually retrain the body and the brain back to a normal protection setting and a resumption of usual activities.
Sensorimotor training not new
Sensorimotor training isn‘t new.
It’s a process that emphasises postural control and progressive challenges to the sensorimotor system to restore normal motor programs in patients with chronic musculoskeletal pain.
In the new study, sensorimotor retraining leads patients to see that their brain and back are not communicating well, and can experience an improvement in this communication.
Professor Ben Wand of Notre Dame University, the clinical director on the trial, said this approach gives patients ‘‘confidence to pursue an approach to recovery that trains both the body and the brain”.
The study authors say that more research is needed to replicate these results and to test the treatment in different settings and populations.
This suggests the treatment won’t be available any time soon – and that the treatment hasn’t proven itself – but that’s not the case.
Professor McAuley hopes that in the next six to nine months, the new treatment will be available via trained physiotherapists, exercise physiologists and other clinicians.
He said these patients ‘‘should be able to access it at a similar cost to other therapies offered by those practitioners’’.
