New chronic back pain treatment offers hope

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Relationships decline between chronic pain sufferers and their pharmacists

There’s hope for those suffering from chronic back pain with the discovery of a new treatment option, which focuses on retraining how the back and the brain communicate.

A randomised controlled trial by researchers at UNSW Sydney and Neuroscience Research Australia (NeuRA) published in the Journal of the American Medical Association, has found promising results from a program that retrains the brains of those with back pain, helping them get moving faster.

The study looked at 12 treatment sessions that involved pain education and help for people to retrain their brains to process sensory information from their backs differently.

At the same time, people underwent movement training and did at-home exercises that started with simply spinal movements and increased to more complex exercises, such as squatting, lunging, or lifting.

On a scale of 0 (no pain) to 10 (the worst pain) people who followed the program had pain levels that dropped from 5.6 to 3.2 after 18 weeks.

Professor James McAuley from UNSW’s School of Health Sciences and NeuRA says sensorimotor retaining 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,” says Professor McAuley.

“People were happier, they reported their backs felt better and their quality of life was better.

“It also looks like these effects were sustained over the long term; twice as many people were completely recovered.

Very few treatments for low back pain show long-term benefits, but participants in the trial reported improved quality of life one year later,” he says.

The new treatment challenges traditional treatments for chronic back pain, such as drugs and treatments that focus on the back such as spinal manipulation, injections, surgery, and spinal cord stimulators, by viewing long-standing 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 looking at opioid treatment versus placebo, the difference for that is less than one point out of 10 in pain intensity, it’s only short term and there is little improvement in disability,” says Professor McAuley.

“We see similar results for studies comparing manual therapy to sham or exercise to sham.

“This is the first new treatment of its kind for back pain – which has been the number one cause of the Global Disability Burden for the last 30 years – that has been tested against placebo.”

Traditional therapies concentrate on fixing something in your back, injecting a disc, loosening up the joints or strengthening the muscles.

According to Professor McAuley, what makes sensorimotor retraining different is that it looks at the whole system – what people think about their back, how the back and brain communicate, how the back is moved, as well as the fitness of the back.

The study authors say that 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 similar disruption within the nervous system.

They are optimistic about rolling out a training package to bring this new treatment to clinics and have enlisted partner organisations to start that process.

Once the new treatment is available via trained physiotherapists, exercise physiologists and other clinicians – Professor McAuley hopes this to occur 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.