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MusculoskeletalAug 3, 2022

Physios could offer a new treatment that targets the nervous system to people with chronic back pain

Physiotherapists, exercise physiologists and other clinicians could start offering a novel treatment programme to people with long-term back pain within the next six to nine months, according to a psychologist, James McAuley. Professor McAuley, who is based at UNSW Sydney and Neuroscience Research Australia (NeuRA), is a one of the authors of a paper published earlier this week (2 August) in the Journal of the American Medical Association.

The lead author is Matthew K Bagg, a physiotherapist and clinical scientist based at NeuRa, an independent, not-for-profit research institute based in Sydney, Australia. The treatment programme, which focuses on retraining how the back and the brain communicate, was put to the test in a randomised control trial (RCT) run by researchers from UNSW Sydney and NeuRA and several other Australian and European universities.

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A training package could be rolled out to practitioners over the next six to nine months

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Novel approach used

What we observed in our trial was a clinically meaningful effect on pain intensity and a clinically meaningful effect on disability. People were happier, they reported their backs felt better and their quality of life was better [James McAuley]

In the RCT study, which was conducted at NeuRA, 276 participants were divided into two groups: one group undertook a 12-week course of sensorimotor retraining, while the other received a 12-week course of sham treatments designed to control for placebo effects.

Professor McAuley, whose comments appear on NeuRa’s website, said sensorimotor retraining 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. 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. He noted: ‘Very few treatments for low back pain show long-term benefits, but participants in the trial reported improved quality of life one year later.'

Proponents of the approach view 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. We see similar results for studies comparing manual therapy to sham or exercise to sham,’ Professor McAuley said.

‘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.'

How it works

Professor McAuley said the treatment is based on research showing the nervous system of people suffering from chronic back pain behaves differently from people who have a recent injury to the lower back. ‘People with back pain are often told their back is vulnerable and needs protecting. This changes how we filter and interpret information from our back and how we move our back.'

Over time, the back becomes less fit, and the way the back and brain communicate is disrupted in ways that seem to reinforce the notion that the back is vulnerable and needs protecting. The treatment we devised aims to break this self-sustaining cycle, he explained.

The treatment aims to achieve three goals

  • to align patient understanding with the latest scientific understanding about what causes chronic back pain
  • to normalise the way the back and the brain communicate with each other
  • to gradually retrain the body and the brain back to a normal protection setting and a resumption of usual activities

Physiotherapist Ben Wand

Physiotherapist Ben Wand from The University of Notre Dame, Fremantle, Western Australia, is the trial's clinical director. He emphasised that by using a programme of sensorimotor training, patients can see that their brain and back are not communicating well, but can also experience an improvement in this communication. Professor Wand said: ‘We think this gives them confidence to pursue an approach to recovery that trains both the body and the brain.’

Speaking to PhysioUpdate, he said: 'Interested practitioners and people with back pain can find out more and register their interest for further information on the website. Visit: https://www.neura.edu.au/project/resolve-clinical-trial/

Training the body and the brain

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 from trained physiotherapists, exercise physiologists and other clinicians – Professor McAuley hopes this will happen in six to nine months' time – people with chronic back pain should be able to access it at a similar cost to other therapies offered by those practitioners.

To read the full release on the NeuRa website, visit: https://www.neura.edu.au/news/an-effective-new-treatment-for-chronic-back-pain-targets-the-nervous-system/

To read the full version of the article, titled Effect of Graded Sensorimotor Retraining on Pain Intensity in Patients With Chronic Low Back Pain: A Randomized Clinical Trial, visit: https://dx.doi.org/10.1001/jama.2022.9930

Author: Ian A McMillan
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