A new drug-free treatment that “retrains” the brain may provide better long-term back pain relief than opioids, a study has suggested.
Patients saw significant improvements after the 12-week course, which consisted of one hour each week with a physical therapist.
dr. Neil O’Connell, who worked on the trial at Brunel University, London, said: “These results are promising.”
About 11 million people in the UK and 65 million in the US suffer from back pain, making it the leading cause of disability.
Traditional therapies focus on repairing something in the back, such as injecting a disc, manipulating joints, strengthening the muscles, or surgery.
But ‘sensorimotor retraining’ is changing the way people think about their condition so that they no longer see it as a defect or an obstacle to movement.
Patients seeking treatment for back pain reported significant improvements after the 12-week course of one hour of therapy, which consisted of one hour with a therapist per week
What is sensorimotor retraining?
Sensorimotor retraining is designed to change how people think about their body when it’s in pain, how they process that information, and how they move.
The goal is to help patients understand that exercise is safe and helpful in coping with long-term pain, so that they feel safe doing it and give them that experience.
In practice, the retraining initially includes educational videos explaining the science behind pain and how it is activated, precision sensory training and mental rehearsal of movements.
Patients then move on to doing simple movements before moving on to complex exercises such as squatting, lunging, and lifting.
Researchers from the University of New South Wales tested the therapy in 276 patients with chronic low back pain.
Half completed the sensorimotor course and the rest received ‘sham treatments’.
The participants were 46 years old on average and were evenly distributed in terms of gender.
Patients on the course attended physical therapy sessions that taught them how back pain was a modifiable problem of the nervous system, rather than a physical one.
During the process, they also watched videos of other people bending over and standing up.
This is because just thinking about the moves can trigger some of the same pathways as actually doing it, the researchers say.
After learning to see their pain in a different light, the participants moved on to trying more complex maneuvers, such as squats and lunges.
They also repeated some of these exercises at home for 30 minutes five times a week.
The idea behind the retraining is that patients with low back pain often have a less fit back because they shy away from physical activity in an effort to calm themselves.
This shelter disrupts the normal way the brain and back communicate through the nervous system, making it hypersensitive to pain.
As a result, the researchers claimed it could leave patients in a self-perpetuating cycle that only aggravates their condition.
The sensorimotor retraining was intended to break this cycle and help the brain communicate normally with the back.
After 18 weeks, participants were asked to rate their back pain out of 10 and this was compared to the score at the start of the study.
Retraining patients saw their pain score drop on average from 5.6 to 3.1.
In patients in the sham treatment group, where their backs were zapped with lasers and weak electrical currents, their average pain score only dropped from 5.8 to 4.
After 26 weeks, 18.3 percent of the sensorimotor group met the criteria for “recovery,” compared to just 9.8 percent in the sham group.
Professor James McAuley, a psychologist at the University of New South Wales who also worked on the study, said the results challenge current methods of treatment for chronic back pain, such as the use of opioid painkillers.
“If you compare the results to studies of opioid treatment versus placebo, the difference for that is less than one in ten in pain intensity, it’s only short-lived, and there’s little improvement in disability,” he said.
He added that the sensorimotor retraining had made an incredible and long-lasting difference in the way the patients coped with their pain.
“People were happier, they reported that their backs felt better and their quality of life was better,” he said.
‘It also appears that these effects will persist in the long term; twice as many people were fully recovered.
“Very few treatments for low back pain provide long-term benefits, but study participants reported improved quality of life one year later.”
The therapy could be more widely available within six to nine months. The findings were published in the Journal of the American Medical Association.
The use of drugs in pain management has come under scrutiny in recent years due to an increase in opioid addiction in the US.
There are also fears of a similar burgeoning crisis in the UK, with opioid hospital admissions skyrocketing over the past decade as more Britons use painkillers while on the NHS waiting lists for surgeries such as hip or knee replacements.