A new drug-free treatment that retrains the brain and the body to communicate with each other effectively could provide relief to chronic back pain sufferers, a new study has found.
Published today in the Journal of the American Medical Association, the study divided 276 participants into two groups – one 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.
It was funded by the National Medical Health and Research Council (NHMRC) and carried out by UNSW Sydney and Neuroscience Research Australia (NeuRA), and several other Australian and international universities.
According to Professor James McAuley from UNSW’s School of Health Sciences, and NeuRA, 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,” he says.
“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.”
The new treatment challenges traditional treatments for chronic back pain, such as drugs and therapies 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. We see similar results for studies comparing manual therapy to sham or exercise to sham,” Professor McAuley points out.
How does it work?
The treatment is based on research that shows the nervous system of people suffering from chronic back pain behaves in a different way from people who have sustained 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,” Professor McAuley says.
The treatment, which includes specially designed education modules and methods and sensorimotor retraining, aims to correct the dysfunction involved in most chronic back pain – a disruption within the nervous system. The disruption results in two problems: a hypersensitive pain system and imprecise communication between the back and the brain.
The treatment aims to achieve three goals. The first is to align patient understanding with the latest scientific understanding about what causes chronic back pain. The second is to normalise the way the back and the brain communicate with each other, and thirdly, to gradually retrain the body and the brain back to a normal protection setting and a resumption of usual activities.
Professor Ben Wand, of Notre Dame University, the clinical director on the trial, emphasised that by using a program of sensorimotor training, patients can see that their brain and back are not communicating well, but can also experience improvement in this communication.
“We think this gives them confidence to pursue an approach to recovery that trains both the body and the brain,” he suggests.
Training the body and the brain
Traditional therapies concentrate on fixing the back, such as injecting a disc, loosening up the joints or strengthening the muscles. What makes sensorimotor retraining different, according to Professor McAuley, 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’s authors say that more research is needed to replicate the results and to test the treatment across 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 the new treatment to clinics within the next six to nine months, delivered via trained physiotherapists, exercise physiologists and other clinicians.
Read the full study here
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