Psychological therapy can effectively treat chronic low back pain

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A new study concludes that psychological therapy may be an effective treatment for some forms of back pain. Mads Perche / Getty Images
  • A recent study found that people with chronic mild to moderate back pain who received retreatment pain therapy (PRT) experienced significant reductions in pain intensity after treatment, most people now these reductions for 1 year.
  • A total of 66% of participants receiving PRT were painless or almost painless after treatment.
  • Scientists will need to do more research to assess the usefulness of PRT in treating other forms of primary chronic pain.

Back pain is the most common type of chronic pain, according to the authors of the recent study.

Most acute back pain, which lasts less than 4 weeks, usually improves within a few days to a few months. Always, up to 33% of people may experience moderate back pain 1 year later, with 20% having significant physical limitations.

The authors explain that for 85% of people with chronic low back pain, there is no identifiable cause.

The American College of Physicians (ACP) has published clinical guidelines that strongly recommend the preferential use of non-pharmacological agents to treat chronic low back pain, which it defines as pain lasting longer than 12 weeks. These therapies include:

For people who do not respond to these treatments, the PCA guidelines recommend nonsteroidal anti-inflammatory drugs first. If that doesn’t work, doctors can try duloxetine, which is an antidepressant, or tramadol, which is an opioid.

However, the guidelines suggest that doctors should only use opioids when the potential benefits outweigh the risks.

While these therapies may improve functioning in some people, others experience limited reductions in pain intensity.

These mixed responses have led researchers at the University of Colorado at Boulder to develop and test PRT as a potential treatment for chronic back pain. The results of the study appear in JAMA Psychiatry.

Dr Yoni Ashar, Ph.D., lead author of the study, explained to Medical News Today: “A lot of people believe, and are told by doctors and others, that pain is a sign of tissue damage. The belief is that whenever you feel pain, it means you are damaging your back.

Dr Ashar added: “Brain sensitization occurs due to a vicious cycle: pain induces fear (this is natural), which leads to hypervigilance and avoidance, which leads to more of pain.

After ruling out the identifiable causes of chronic back pain, PRT involves exercises that aim to help people understand that the source of their pain is not from an injury but from altered brain pathways, which are modifiable.

Dr. Ashar explained how “guided meditations […] induce a passage from the avoidance of bodily sensations to an engagement with them with an attitude of curiosity and lightness, knowing that they are safe.

Researchers conducted a randomized controlled study from August 2017 to November 2019. The participants were between 21 and 70 years old and based in Boulder, CO. All individuals reported having back pain for at least half of the days in the past 6 months.

Participants received PRT, placebo, or just their usual care. Members of the PRT group first received a one-hour telehealth assessment and education session with a physician. They then underwent eight one-to-one hour-long PRT sessions with a therapist, which took place twice a week for 4 weeks.

People in the placebo group watched two videos explaining how placebo treatments contribute to the body’s healing response. They also received an injection of saline solution at the site of greatest pain and continued with care.

The researchers measured the average back pain intensity score over a week after treatment. They also used three methods to assess participants’ beliefs about pain and conducted Functional MRI (fMRI) to measure responses to evoked pain and persistent pain after rest.

The study analyzed data from 135 participants – 44 in the PRT group, 44 in the placebo group, and 47 in the usual care group.

At the start of the study, participants had suffered from chronic back pain for an average of 10 years, with an average pain intensity score of 4.10 out of 10. They were on average 41 years old and 54% were female. .

Participants in the PRT group experienced a significant reduction in mean pain scores compared to those in the placebo and usual care groups: a decrease of 1.79 and 2.40 on the 0-10 scale, respectively.

A total of 66% of people in the PRT group, 20% in the placebo group, and 10% in the standard care group had little or no pain after treatment.

The mean pain scores at 1 year follow-up were 1.51 in the PRT group, 2.79 in the placebo group, and 3.00 in the usual care group.

Dr Ilan Danan is a sports neurologist and pain management specialist at the Center for Sports Neurology and Pain Medicine at Cedars-Sinai Kerlan-Jobe Institute in Los Angeles. He did not participate in the study but spoke with MNT.

Dr Danan said he found the results “reassured”. He explained how “patients often don’t turn to non-pharmacological products. […] way to treat pain, especially in a chronic pain scenario.

He added: “So to find ongoing evidence through these studies […] support the use of non-pharmaceutical means to treat chronic pain, […], we need to pursue it as clinicians and address it with our patients.

The study has many strengths. For example, he used a randomized, controlled design with active control and placebo groups and used fMRI as an objective measure to correlate treatment effects with validated pain scores.

However, the participants were predominantly white and well-educated with low to moderate pain and disability at baseline, which limits the generalizability of the results.

Scientists will need to conduct more studies to assess the usefulness of PRT for treating other types of chronic pain.

Dr Ashar commented, “The pain is still 100% real. The key to successful treatment is understanding what causes the pain – in some cases the causes are complex, [but] in other cases, the pain is mainly due to changes in the brain pathways.

He added, although “PRT is not appropriate [to treat] pain secondary to acute injury or inflammation, […] we hope our work will help change the paradigm. Combined psychological and behavioral treatments can eliminate or significantly reduce pain in a significant portion of patients with chronic pain.


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