Helping people with more disabling low back pain

A few years ago, the Pain-Ed team published a randomised clinical trial showing that our approach can have a significant effect on pain and disability for people with low back pain, and more than traditional therapies like manual therapy and exercise combined. That study included a range of patients, with the average severity being low to moderate. The results were very encouraging. However, it was not clear that the same effect would be possible among people with more disabling back pain.

As a result, we decided to examine the effect of our approach among people who were significantly more disabled. This recently published study of ours showed that among people at a secondary care pain clinic, a relative short (average of eight treatment sessions over three months) amount of treatment using this approach significantly reduced pain and disability, and this effect lasted as the patient self-managed for 12 months. This adds further evidence to our hypothesis that (i) taking a broader view of pain (e.g. not focussing exclusively on spinal tissues like discs) and (ii) matching the emphasis of treatment (e.g. sleep deprivation, stress, fear, physical habits) to what each individual needs to overcome pain can improve outcomes for people with persistent pain.

An important consideration is that this is not a randomised clinical trial, so there are other reasons why their pain may have improved (e.g. natural improvement with time, or placebo effects). However, in three measurements over the previous two months their pain and disability had remained relatively unchanged, suggesting at least natural recovery alone seems unlikely to explain the effect.

The next stage – to examine the effects on a even wider range of people with low back pain in another randomised clinical trial is underway and should be complete in 2016.

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