Study: Therapy sessions may be key to drug-free treatment for chronic back pain


A new drug-free treatment that ‘retrains’ the brain can provide better long-term relief from back pain than opioids, a study has found.

Patients reported significant improvements after the 12-week course, which consisted of one hour with a physiotherapist each week.

Dr Neil O’Connell, who worked on the trial at Brunel University, London, said: ‘These results show real promise.’

Around 11million people in the UK suffer from back pain, making it the leading cause of disability.

‘Sensorimotor retraining’ changes the way people think about their condition, so they no longer see it as a defect or barrier to movement.

The course alters the way people process feelings from their back – patients watch videos of others performing back movements, before copying the moves themselves. 

Patients seeking treatment for back pain reported significant improvements after the 12-week course of one-hour therapy, which consisted of one hour with a therapist each week

What is sensorimotor retraining?

Sensorimotor retraining is designed to alter how people think about their body when it is in pain, how they process that information, and how they move.

The aim is to help suffers understand it is safe and helpful in dealing with long term pain to move, helping them feel safe to do so and giving them that experience. 

In practise, the retraining initially involves educational videos explaining the science behind pain and how it is triggered, sensory precision training, and mental rehearsal of movements.

Patients then progress to doing simple movements before progressing to complex exercises like squatting, lunging, and lifting.

 

Researchers analysed 276 Australian patients with chronic lower back pain, with half completing the course and the rest given ‘sham’ treatments.

Participants had an average age of 46, and were split evenly in terms of gender. 

Patients in the sensorimotor retraining arm of the study undertook physiotherapy sessions that involved being educated about how back pain works, training of how the body feels pain, and mental rehearsing of movements that might trigger pain.  

Participants then eventually progressed to doing gradually more intense exercises.

They also repeated some of these exercises at home for 30 minute sessions five times per week.

The idea behind the retraining is that patients with lower back pain often have less fit backs as they do less physical activity to try and protect themselves from triggering pain.

This sheltering of the back disrupts the normal way the brain and back communicate via the nervous system making it hypersensitive to pain and putting suffers in a self-sustaining cycle that they need to protect their back, the researchers said. 

The sensorimotor retraining aimed to break this cycle and help the brain to communicate with the back normally. 

In comparison to the retraining group, the sham group were treated with laser and electrical therapies. 

After 18 weeks, participants were asked to rate their back pain out of 10 and this was compared to the score at the start of the study.

Sensorimotor retraining patients saw their pain score decrease from 5.6 to 3.1 on average.

Sham treatment patients only had their average pain scores decrease from 5.8 to 4. 

After 26 weeks, 18.3 per cent in the ‘real’ group met the criteria for ‘recovery’ compared with only 9.8 per cent in the ‘sham’ group.

Professor James McAuley, a psychologist at the University of New South Wales who also worked on the study, said the results challenged the current treatment methods for chronic back pain like using opioid painkillers.

‘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,’ he said. 

He added the sensorimotor retraining had made an incredible and long-term difference to how patients dealt with their pain.  

‘People were happier, they reported their backs felt better and their quality of life was better,’ he said. 

‘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.’

The therapy could be more widely available in six to nine months. The findings were published in the Journal of the American Medical Association. 

About 52 million Americans and 568 million people worldwide are estimated to suffer from lower back pain

Using drugs in pain management has come under scrutiny in recent years due to a rise in opioid addiction in the US.

There are also fears of a similar burgeoning crisis in the UK, with opioid hospitalisations soaring over the last decade as more Britons turn to painkillers while on NHS waiting lists for operations like hip or knee replacements. 

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