Effective new treatment for chronic back pain targets the nervous system

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People with chronic back pain have been given hope thanks to a new treatment focused on re-educating communication between the back and the brain, a randomized controlled trial led by researchers from UNSW Sydney and Neuroscience Research Australia (NeuRA) and several other Australian and European universities. showed.

The study, funded by the Australian National Health and Medical Research Council (NHMRC), was described today in an article published in the Journal of the American Medical Association. The study, conducted at NeuRA, divided 276 participants into two groups: one received a 12-week course of sensorimotor rehabilitation and the other received a 12-week course of sham treatments designed to control placebo effects, which are common in the lower back. pain trials.

Professor James McAuley from the UNSW School of Health Sciences and NeuRA said sensorimotor rehabilitation changes how people think about their bodies in pain, how they process sensory input from their backs and how they move their back during activities.

“What we observed in our trial was a clinically significant effect on pain intensity and a clinically significant effect on disability. People were happier, they reported that their backs felt better and their quality life was better long-term; twice as many people fully recovered Very few treatments for low back pain show long-term benefits, but trial participants reported improved quality of life at one year later. “

The new treatment challenges traditional treatments for chronic back pain, such as medication and back-focused treatments such as spinal manipulation, injections, surgery and spinal cord stimulators, by considering long-standing back pain as a modifiable nervous system problem rather than a disc, bone, or muscle problem.

“If you compare the results to studies looking at opioid treatment versus placebo, the difference is less than one in 10 points in pain intensity, it’s only short term and there’s little improvement in disability. We see similar results for studies comparing manual therapy to pretend or exercise to pretend,” said Professor McAuley.

“This is the first new treatment of its kind for back pain – which has been the leading cause of the global burden of disability for the past 30 years – that has been tested against a placebo.”

How it works

Professor McAuley said the treatment is based on research which has shown that the nervous systems of people with chronic back pain behave differently from people who have recently suffered a lower back injury.

“People with back pain are often told that their back is vulnerable and needs to be protected. 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 the brain communicate is disrupted in a way that seems to reinforce the notion that the back is vulnerable and needs to be protected.The treatment we have designed aims to break this self-perpetuating cycle “, did he declare.

Professor Lorimer Moseley AO, Bradley Professor Emeritus at the University of South Australia, said: “This treatment, which includes specially designed education modules and methods and sensorimotor rehabilitation, aims to correct the dysfunction we We now know it’s involved in most chronic back pain and it’s a disruption within the nervous system. The disruption leads to two problems: an oversensitive pain system and inaccurate communication between the back and the brain.”

The treatment aims to achieve three goals. The first is to align the patient’s understanding with the latest scientific knowledge about the causes of chronic back pain. The second is to normalize the way the back and brain communicate with each other, and third, to gradually retrain the body and brain to a normal protective setting and return to normal activities.

Professor Ben Wand of the University of Notre Dame, clinical director of the trial, pointed out that by using a sensorimotor training program, patients can see that their brain and back are not communicating well, but can also see improvement of this communication. He said: “We think it gives them the confidence to pursue a recovery approach that trains both body and brain.”

Body and brain training

Traditional therapies focus on fixing something in your back, injecting a disc, loosening joints, or strengthening muscles. According to Professor McAuley, what makes sensorimotor rehabilitation different is that it looks at the whole system – what people think about their back, how the back and the brain communicate, how the back is moved, as well than the fitness of the back.

The study authors say more research is needed to replicate these findings and test the treatment in different settings and populations. They also want to test their approach in other chronic pain states that show similar disturbances within the nervous system. They are optimistic about rolling out a training program to bring this new treatment to clinics and have recruited partner organizations to start this process.

Once the new treatment becomes available through trained physiotherapists, exercise physiologists and other clinicians – Professor McAuley hopes this will happen within the next six to nine months – people with chronic back pain should to be able to access it at a cost similar to that of other therapies offered by these practitioners.

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