New chronic back pain trial reports significant improvements

A new treatment, tested by Curtin University, Macquarie University and Monash University, is said to have helped long-term sufferers of chronic back pain experience ‘dramatic reductions’ in pain and related disability.

The research, involving 500 people who had been seeking help for their pain for an average of four years before trialling the new treatment, found large clinically significant improvements in the intensity of pain and pain-related disability.

The treatment took a whole-person approach by also helping people to make lifestyle changes aimed at improving their social and emotional health, and it delivered a healthcare and work productivity saving of more than $5000 per person.

Personalised and intensive coaching sessions

Called cognitive functional therapy (CFT), the treatment offered personalised and intensive coaching sessions that helped people make sense of their pain, focused on retraining them to move in ways that reduced their pain and built confidence in movements and activities they had been afraid of or were avoiding. The treatment was delivered in 20 clinics across Perth and Sydney by 18 physiotherapists who were specifically trained to deliver CFT.

Participants living with chronic back pain — including many who had high levels of disability — tested the program in up to seven sessions over a 12-week period, followed by a booster session at six months. They were followed up by questionnaires until 12 months. More than 80% of the participants were satisfied with the treatment.

A clear roadmap

Lead author Associate Professor Peter Kent, from the Curtin School of Allied Health, said the findings produced compelling evidence that the new treatment had a large and lasting impact at a “clinically important” level.

“Lower back pain is the leading cause of disability across the globe, contributing to a loss of work productivity and early retirement worldwide,” Associate Professor Kent said.

“These exciting results give hope to the millions of people around the world who are disabled by back pain. It also provides a clear roadmap for clinicians, health services and policymakers on how to reduce the growing burden of chronic back pain with a high-value, low-risk approach based on the best scientific evidence.”

Patient-centred care

Co-author Professor Peter O’Sullivan, also from the Curtin School of Allied Health, who developed the new treatment, said it put the patient at the centre of care.

“This new treatment takes on board the individual characteristics of the person who has been living with chronic back pain by addressing their concerns and movement limitations under the skilled guidance of a trained physiotherapist,” Professor O’Sullivan said.

“This differs to traditional, more passive approaches — including massage, spinal manipulation, medication and injections — because it puts the person in charge of their condition, helping them to understand the factors contributing to their pain, building control and confidence in their body to get back to valued activities. It was particularly rare and thrilling to discover that the significant reduction in pain and distress that these people living with chronic back pain experienced had remained right up to one year after trialling this new treatment.”

Economic efficiency

Co-author Professor Terry Haines, from Monash University, who investigated the economic efficiency, “The main economic efficiency results showed participants who took part in the CFT treatment saved more than $5000 per person, largely driven by improvements in their productivity in both paid and unpaid work.

“This has the potential to deliver significant savings to the global economy because we know the burden that lower back pain is contributing to a loss of work productivity and early retirement worldwide.”

Specialised training

Co-author Professor Mark Hancock, from Macquarie University, said the physiotherapists who carried out the new treatment across Perth and Sydney had experience in treating people with persistent lower back pain and underwent specialised training over five months to deliver the care set out in the new treatment.

“An important learning from our study was that it took quite a lot of training for physiotherapists to develop the skills and confidence to become competent to deliver the intervention at a high standard, despite the fact that many were already experienced,” Hancock said. “The training included practice on real patients and receiving feedback from the trainers.”

An international team of back pain experts, led by researchers from Curtin and Macquarie University in partnership with researchers from Monash University, the University of Limerick, Imperial College London, the University of Southern Denmark and The University of Western Australia, conducted the research.

The full paper has been published in The Lancet journal and can be viewed online here.

Image caption: Trial participant Volker Rehbocks and Curtin Professor Peter O'Sullivan. Image credit: Curtin University.