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

Summary: A newly developed technique called sensorimotor retraining appears to be effective in treating chronic low back pain.

A source: University of New South Wales

A new treatment aimed at retraining the back-brain connection in people with chronic back pain has given hope in a randomized controlled trial led by researchers from UNSW Sydney and Neuroscience Research Australia (NeuRA) and several other Australian and European universities. showed.

The study, funded by Australia’s National Health and Medical Research Council (NHMRC), is reported in an article published today in the journal. Journal of the American Medical Association. A study conducted at NeuRA divided 276 participants into two groups: one received a 12-week course of sensorimotor retraining, and the other received a 12-week course of sham treatment designed to control the placebo effects common in the lower back. pain tests.

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

“What we saw in our trial was a clinically meaningful effect on pain intensity and a clinically meaningful effect on disability. People reported feeling happier, with better backs, and improved quality of life. And these effects seemed to be long-lasting; twice as many people had full recovery. Fewer treatments show long-term benefits, but trial participants reported improved quality of life after one year.

New traditional treatments for chronic back pain, such as surgery, drugs and treatments that target the spine, such as spinal manipulation, injections, and spinal cord stimulators. disc, bone or muscle problem.

“If you compare the results with studies looking at opioid treatment with placebo, the difference is less than 1 in 10 points in pain intensity, it’s only short-term and there’s little improvement in disability. “We see similar results in studies comparing manual therapy to sham or exercise to sham,” said the professor. Macaulay said.

“This is the first treatment for low back pain, the leading cause of the global burden of disability for the past 30 years, to be tested against a placebo.”

how it works

Prof. McAuley said the treatment is based on research showing that the nervous system of people with chronic back pain behaves differently than people with recent lower back injuries.

“People with back pain are told that their backs are vulnerable and need protection. It changes how we filter and interpret information from our backs and move our backs. Over time, the arch becomes less functional and the connection between the arch and the brain is disrupted, reinforcing the notion that the arch is vulnerable and in need of protection. The treatment we’ve come up with is aimed at breaking this self-perpetuating cycle,” he said.

Professor Lorimer Moseley AO, Bradley Distinguished Professor at the University of South Australia, said: “Incorporating specially designed educational modules and techniques and sensorimotor retraining, this treatment aims to correct the dysfunction we know is involved in the majority of chronic low back pain disorders within the nervous system. Disruption leads to two problems: a hypersensitive pain system and an inaccurate connection between the spine and the brain.

A new treatment challenges traditional treatments for chronic back pain. Image is in the public domain

Treatment is aimed at achieving three goals. The first is to reconcile the patient’s understanding with the latest scientific understanding of what causes chronic low back pain. The second is to normalize the connection between the back and the brain, and the third is to gradually retrain the body and brain to a normal protective state and resume normal activities.

The trial’s clinical director, University of Notre Dame Professor Ben Wand, noted that using the sensorimotor training program, patients could see that their brains and spines were not communicating well, but they could also see improvements in that connection. He said: “We think this will give them the confidence to use a recovery approach that trains both the body and the brain.”

Exercise the body and mind

Traditional therapies focus on strapping something to your back, injecting a disc, loosening joints, or strengthening muscles. What makes sensorimotor retraining different, says prof. McAuley looks at the whole system – what people think about the back, how the back and the brain connect, how the back moves, and 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 disease states that show similar disruption within the nervous system. They are optimistic about rolling out the training package to bring this new treatment to clinics and have invited partner organizations to start the process.

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

This is about disease research news

Author: Lachlan Gilbert
A source: University of New South Wales
The connection: Lachlan Gilbert – University of New South Wales
Photo: 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” James McAuley et al. JAMA


Abstract

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

an important

In chronic pain, the effect of altered neural processing, defined as changes in neural networks responsible for pain and function perception, remains unclear.

The goal

See also

It shows the brain

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

Design, installation and participants

This parallel, 2-group, randomized clinical trial recruited participants with chronic (> 3 months) nonspecific low back pain from primary care and community settings. A total of 276 adults were randomized (1:1 ratio) to intervention or sham and attention control groups delivered by clinics at the Medical Research Institute in Sydney, Australia. The first participant was randomized on December 10, 2015, and the last on July 25, 2019. The survey ended on February 3, 2020.

interventions

Participants in the intervention group (n = 138) were randomized to 12 weekly clinical sessions and home training, designed to educate them and help them with movement and physical activity while experiencing back pain. Randomized participants in the control group (n = 138) were asked to participate in 12 weeks of clinical sessions and home training, which were as time-consuming as the intervention but did not focus on education, movement, and physical activity. The control group received back-applied sham laser and short-wave diathermy and sham non-invasive brain stimulation.

Main outcomes and measures

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

Results

Among 276 randomized patients (avg [SD] young, 46 [14.3] years; 138 [50%] women), 261 (95%) completed follow-up at 18 weeks. 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 a mean between-group difference of −1.0 points at 18 weeks ([95% CI, −1.5 to −0.4]; P= .001), favoring the intervention group.

Conclusions and relevance

In this randomized clinical trial conducted in one center among patients with chronic low back pain, graded sensorimotor retraining significantly improved pain intensity in 18 weeks, compared to sham procedure and attention control. The improvement in pain intensity was small and further studies are needed to understand the generalizability of the results.

Trial registration

ANZCTR ID: ACTRN12615000610538

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