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

Summary: 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 been given hope with a new treatment focused on retraining how the back and brain communicate, a randomized controlled trial run by researchers at the University of New South Wales in Sydney, Neuroscience Research Australia (NeuRA) and several other Australian and European universities showed .

The study, funded by the Australian National Health and Medical Research Council (NHMRC), is described today in a paper published in Journal of the American Medical Association. The study, conducted at NeuRA, divided 276 participants into two groups: one who went through a 12-week course of sensorimotor retraining and the other received a 12-week sham treatment course designed to control for placebo effects, which are common in the lower back. Pain trials.

Professor James McCauley of the University of New South Wales School of Health Sciences and Nora said sensory retraining changes the way people think about their bodies in case of pain, how they process sensory information from their backs and how they move their backs 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, reported that their backs felt better and their quality of life was better. It also appears that these effects persisted over the long term; twice as many healed People completely. Very few treatments for low back pain show long-term benefits, but trial participants reported improved quality of life after one year.”

The new treatment challenges traditional treatments for chronic back pain, such as medication and back-focused treatments such as spinal manipulation, injections, surgery and spinal cord stimulators, by viewing chronic back pain as a modifiable problem of the nervous system instead. From a disc, bone or muscle problem.

“If you compare the results to studies looking at opioid therapy versus placebo, the difference is less than 1 point out of 10 in pain intensity, it is only short-term and there is little improvement in disability. We see similar results for studies that You compare manual therapy to deception, or exercise to deception.”

“This is the first new treatment of its kind for back pain – which has been the number one cause of the global burden of disability for the past 30 years – that has been tested against a placebo.”

How it works

Professor McCauley said the treatment was based on research that showed the nervous system of people with chronic back pain behaves differently than people who had a recent lower back injury.

People with back pain are often told that their backs are at risk and need 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 weak and needs protection. The treatment we created aims to break this cycle of self-sufficiency.”

Professor Lorimer Mosley AO, Bradley Distinguished Professor at the University of South Australia, said: “This therapy, which includes specially designed units, teaching methods and retraining of the senses, aims to correct the dysfunction we now know to cause most chronic back pain and that is a systemic disorder. This disorder results in two problems: the highly sensitive pain system and the imprecise communication between the back and the brain.”

A new treatment challenges conventional treatments for chronic back pain. The image is in the public domain

Treatment aims to achieve three goals. The first is to align patient understanding with the latest scientific understanding 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 position and resume normal activities.

Professor Ben Wand of the University of Notre Dame, clinical director of the trial, confirmed that by using the sensorimotor training program, patients could see that their brain and back are not communicating well, but they can also experience an improvement in this communication. “We think this gives them confidence to take an approach to recovery that trains both the body and the brain,” he said.

Body and brain training

Conventional treatments focus on fixing something in your back, injecting a disc, relaxing joints or strengthening muscles. What makes sensorimotor retraining different, according to Professor McCauley, is that it looks at the entire system — what people think about their back, how the back and brain communicate, how the back is moved, as well as back fitness.

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

Once the new treatment is available through trained physiotherapists, exercise physiologists and other doctors – Professor McCauley hopes this will happen in the next six to nine months – people with chronic back pain should be able to access it at a cost similar to other treatments offered. by these practitioners.

About this news The search for pain

author: Lachlan Gilbert
source: University of New South Wales
Contact: Lachlan Gilbert – University of New South Wales
picture: The image is in the public domain

original search: Access closed.
“Effect of graded sensorimotor retraining on pain intensity in patients with chronic low back pain” by James McAuley et al. gamma


Summary

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

Importance

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

Goal

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This indicates a brain

To estimate the effect of a graded sensorimotor retraining intervention (resolving) on ​​pain intensity in people with chronic low back pain.

Design, setup and participants

This two-group, randomized, parallel clinical trial recruited participants with unspecified chronic (>3 months) low back pain from primary care and community settings. A total of 276 adults were randomized (in a 1:1 ratio) to intervention or placebo and attention control groups provided by clinicians at the Medical Research Institute in Sydney, Australia. The first participant was randomly selected on December 10, 2015, and the last one was randomly selected on July 25, 2019. Follow-up 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 and assist them with movement and physical activity while suffering from low back pain. Participants randomized to the control group (n = 138) were asked to participate in 12 weekly clinical sessions and home training that required time similar to the intervention but did not focus on education, movement and physical activity. The control group included sham laser, back-applied short-wave diathermy, and noninvasive phantom brain stimulation.

Main findings and measures

The primary outcome was pain intensity at 18 weeks, measured on an 11-point digital rating scale (range, 0). [no pain] up to 10 [worst pain imaginable]) where the minimum clinically significant difference between groups is 1.0 points.

consequences

Among the 276 randomized patients (median [SD] Age 46 [14.3] Years; 138 [50%] women), 261 (95%) completed follow-up at week 18. Mean pain intensity was 5.6 at baseline, 3.1 at 18 weeks in the intervention group, 5.8 at baseline and 4.0 at 18 weeks in the control group, with a mean difference Estimated between group at 18 weeks of -1.0 points ([95% CI, −1.5 to −0.4]; s= .001), in favor of the intervention group.

Conclusions and relevance

In this single center randomized clinical trial among patients with chronic low back pain, graded sensorimotor retraining, compared to placebo and attention control, significantly improved pain intensity at 18 weeks. The improvements in pain intensity were small, and more research is needed to understand the generalizability of the results.

trial recording

ANZCTR ID: ACTRN12615000610538

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