People with chronic back pain have been given hope with a new treatment that focuses on retraining how the back and the brain communicate.
The paper describing the study was published in the Journal of the American Medical Association. The study, carried out at NeuRA, divided 276 participants into two groups: one undertook a 12-week course of sensorimotor retraining and the other received a 12-week course of sham treatments designed to control for placebo effects.
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.
In our trial, we found a clinically meaningful effect on pain intensity and disability. People said their backs felt better and their quality of life was better. It looks like the effects were sustained for a long time. Few treatments for low back pain show long-term benefits, but participants in the trial reported improved quality of life a year later.
Traditional treatments for chronic back pain, such as drugs and treatments that focus on the back, can be challenged by viewing long-standing back pain as a problem of the nervous system.
If you compare the results to studies looking at placebo, the difference for that is less than one point out of 10 in pain intensity, and there is little improvement in disability. The results of studies comparing manual therapy to sham or exercise to sham are the same.
This is the first new treatment of its kind for back pain in 30 years, and it has been tested against placebo.
What does it do?
The treatment is based on research that shows the nervous system of people with chronic back pain behaves differently than people with a recent injury to the lower back.
People with back pain are told they need to protect their back. The way we move our back has been changed by this. The way the back and brain communicate is disrupted in ways that reinforce the idea that the back is vulnerable and needs protection. He said the treatment was designed to break the cycle.
"This treatment, which includes specially designed education modules and methods and sensorimotor retraining, aims to correct the dysfunction we now know is involved in most chronic back pain and that's a disruption within the nervous," said Professor. The disruption causes a hypersensitive pain system and a lack of communication between the back and the brain.
The goal of the treatment is three. Aligning patient understanding with the latest scientific understanding about what causes back pain is the first thing. 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.
By using a program of sensorimotor training, patients can see that their brain and back are not communicating well, but can also experience an improvement in this communication. The approach to recovery that trains both the body and the brain is what he thinks gives them confidence.
The body and the brain need to be trained.
Fix something in your back is one of the traditional therapies. According to Prof. McAuley, sensorimotor retraining looks at the whole system -- what people think about their back, how the back and brain communicate, how the back is moved, and the fitness of the back.
More research is needed to replicate these results and to test the treatment in different settings. They want to see if their approach can disrupt the nervous system in other chronic pain states. They are optimistic about rolling out a training package to bring this new treatment to clinics.
Prof. McAuley wants people with chronic back pain to be able to get the new treatment at a similar price to other therapies.
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