An effective new treatment for chronic back pain targets the nervous system

Overview: A newly developed method called sensorimotor retraining appears to be effective in treating chronic back pain.

Source: University of New South Wales

People with chronic back pain have gained hope with a new treatment that aims to retrain how the back and brain communicate, a randomized controlled trial conducted by researchers from UNSW Sydney and Neuroscience Research Australia (NeuRA) and several other Australian and European universities has shown.

The study, funded by the Australian National Health and Medical Research Council (NHMRC), was described today in a paper published in the Journal of the American Medical Association. The study, conducted at NeuRA, 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 placebo effects, which are often prevent low back pain. taste pain.

Professor James McAuley of the UNSW’s School of Health Sciences and NeuRA said sensorimotor retraining changes how people think about their bodies in pain, how they process sensory information from their backs and how they move their backs during activities.

“What we observed in our study was a clinically meaningful effect on pain intensity and a clinically meaningful effect on disability. People were happier, they reported that their backs felt better and their quality of life was better. “We found that these long-term effects persisted; twice as many people made a full recovery. Very few treatments for low back pain show long-term benefits, but study participants reported improved quality of life a year later.”

The new treatment challenges traditional treatments for chronic back pain, such as drugs and treatments that target the back, such as spinal manipulation, injections, surgery and spinal cord stimulators, by seeing long-term back pain as a modifiable problem of the nervous system rather than a disc. -, bone or muscle problem.

“If you compare the results to studies of opioid treatment versus placebo, the difference between them is less than one in ten in pain intensity, it’s only short-lived and there’s little improvement in disability. We see similar results for studies comparing manual therapy with sham or exercise with sham,” said Prof. McAuley.

“This is the first new treatment of its kind for back pain – which has been the leading cause of the Global Disability Burden for the past 30 years – to be tested with placebo.”

How it works

Prof. dr. McAuley said the treatment is based on research that showed that the nervous systems of people suffering from chronic back pain behave differently than those with a recent lower back injury.

“People with back pain are often told that their back is fragile and in need of protection. This changes how we filter and interpret information from our backs and how we move our backs. Over time, the back becomes less fit and the way the back and brain communicate is disrupted in ways that seem to reinforce the idea that the back is vulnerable and needs to be protected. The treatment we’ve come up with is designed to break this self-perpetuating cycle,” he said.

Professor Lorimer Moseley AO, Bradley Distinguished Professor at the University of South Australia said: “This treatment, which includes specially designed teaching modules and methods and sensorimotor retraining, aims to correct the dysfunction that we now know is involved in the most chronic back pain and that is a disturbance in the nervous system. The disturbance results in two problems: a hypersensitive pain system and inaccurate communication between the back and the brain.”

This shows the back of a woman
The new treatment challenges traditional treatments for chronic back pain. Image is in the public domain

The treatment aims to achieve three goals. The first is to align the patient’s understanding with the latest scientific insights about the causes of chronic back pain. The second is to normalize the way the back and brain communicate with each other, and third, to gradually retrain the body and brain to a normal protective setting and resumption of usual activities.

Professor Ben Wand of Notre Dame University, the clinical director of the study, emphasized that by using a sensorimotor training program, patients can see that their brain and back are not communicating properly, but also experience an improvement in this communication. He said, “We think this gives them confidence to pursue an approach to recovery that trains both the body and the brain.”

Training body and brain

Traditional therapies focus on repairing something in your back, injecting a disc, loosening the joints or strengthening the muscles. What makes sensorimotor retraining different, according to Prof. McAuley, is that it looks at the whole system — what people think about their backs, how the back and the brain communicate, how the back is moved, as well as the condition of the back.

The study authors say more research is needed to replicate these results and to test the treatment in different settings and populations. They also want to test their approach in other chronic pain states that show a similar disruption in the nervous system. They are optimistic about rolling out a training package to bring this new treatment to clinics and have engaged partner organizations to start that process.

Once the new treatment is available through trained physiotherapists, exercise physiologists and other clinicians — Prof. McAuley hopes it will happen in the next six to nine months — people with chronic back pain should be able to access it at a similar cost to other therapies offered by those practitioners.

About this news about pain research

Author: Lachlan Gilbert
Source: University of New South Wales
Contact: Lachlan Gilbert – University of New South Wales
Image: The image is in the public domain

Original research: Closed access.
“Effect of graded sensorimotor retraining on pain intensity in patients with chronic low back pain” by James McAuley et al. JAMA


Abstract

Effect of graded sensorimotor retraining on pain intensity in patients with chronic low back pain

Interest

The effects of altered neural processing, defined as altering neural networks responsible for pain perception and function, on chronic pain remains unclear.

Objective

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Estimating the effect of a graded sensorimotor retraining intervention (RESOLVE) on pain intensity in people with chronic low back pain.

Design, setting and participants

This parallel, 2-group randomized clinical trial recruited participants with chronic (>3 months) non-specific low back pain from primary care and community settings. A total of 276 adults were randomized (in a 1:1) ratio to the intervention or sham procedure and attentional control groups provided by clinicians at a medical research institute in Sydney, Australia. The first participant was randomized on December 10, 2015 and the last one was randomized on July 25, 2019. The follow-up was completed on February 3, 2020.

Interventions

Participants randomized to the intervention group (n = 138) were asked to participate in 12 weekly clinical sessions and home training designed to educate them about and assist them in exercise and physical activity while experiencing low back pain. Participants randomized to the control group (n = 138) were asked to participate in 12 weekly clinical sessions and home training that took the same time as the intervention, but did not focus on education, exercise and physical activity. The control group included sham laser and shortwave diathermy applied to the back and sham non-invasive brain stimulation.

Main results and measures

The primary outcome measure was pain intensity at week 18, measured on an 11-point numerical rating scale (range, 0 [no pain] up to 10 [worst pain imaginable]) for which the minimum clinically important difference between the groups is 1.0 point.

Results

Among 276 randomized patients (mean [SD] age, 46 [14.3] year; 138 [50%] women), 261 (95%) completed follow-up at 18 weeks. The mean pain intensity was 5.6 at baseline and 3.1 at 18 weeks in the intervention group and 5.8 at baseline and 4.0 at 18 weeks in the control group, with an estimated mean difference between the groups at 18 weeks of −1 ,0 point ([95% CI, −1.5 to −0.4]; p= .001), in favor of the intervention group.

Conclusions and relevance

In this single center randomized clinical trial in patients with chronic low back pain, graded sensorimotor retraining, compared with a sham procedure and attentional control, significantly improved pain intensity at 18 weeks. The improvements in pain intensity were small and further research is needed to understand the generalizability of the findings.

Trial Registration

ANZCTR ID: ACTRN12615000610538

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