Graded Sensorimotor Retraining Improved Chronic Low Back PainAugust 3, 2022
Graded sensorimotor retraining significantly reduced pain intensity in people with chronic low back pain, according to a single-center randomized trial.
On an 11-point numerical rating scale, the mean pain intensity decreased by 2.5 points from baseline to 18 weeks in the intervention group compared with a decline of 1.8 points in a group that received a sham procedure and attention control, reported James H. McAuley, PhD, of Neuroscience Research Australia in Sydney, and colleagues.
This translated into a between-group minimum clinically important difference of 1.0 point (95% CI -1.5 to -0.4, P=0.001), they noted in JAMA.
Patients in the intervention group also experienced improved disability (-2.6 points), pain catastrophizing (-6.8 points), and pain self-efficacy (6.1 points) scores, among other designated secondary outcomes.
“What we observed in our trial was a clinically meaningful effect on pain intensity and a clinically meaningful effect on disability,” said McAuley in a statement. “People were happier, they reported their backs felt better and their quality of life was better. It also looks like these effects were sustained over the long term; twice as many people were completely recovered. Very few treatments for low back pain show long-term benefits, but participants in the trial reported improved quality of life one year later.”
The authors also noted that rates of adverse events were low. “Other interventions for low back pain, such as medications, surgery, and spinal cord stimulation, have a greater number of adverse effects,” they wrote.
Moreover, “if you compare the results to studies looking at opioid treatment versus placebo, the difference for that is less than 1 point out of 10 in pain intensity, it’s only short term, and there is little improvement in disability,” McAuley said, noting that low back pain “has been the number one cause of the Global Disability Burden for the last 30 years.”
“People with back pain are often told their back is vulnerable and needs protecting,” he added. “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 brain communicate is disrupted in ways that seem to reinforce the notion that the back is vulnerable and needs protecting. The treatment we devised aims to break this self-sustaining cycle.”
The authors explained that the intention of graded sensorimotor retraining is “to help people in pain understand that it was safe and helpful to move (step 1), feel safe to move (step 2), and experience that it was safe to move (step 3) as they progressed toward re-engagement with meaningful functional goals.”
The intervention consisted of graded premovement treatment sessions spanning 12 to 18 weeks with an exercise physiologist or a physiotherapist, which included sensory precision training and mental rehearsal of movement, as well as a home-based component that participants were encouraged to complete for 30 minutes 5 times per week.
The control group received sham noninvasive brain stimulation, sham laser, and shortwave diathermy for the lower back in hour-long sessions over the course of 12 to 18 weeks, as well as a sham cranial electrical stimulation device, which they were encouraged to use five times a week in 30-minute sessions.
All participants were also asked to keep a log of their home training sessions.
Of 276 patients randomized 1:1 to each treatment (mean age 46 years), 261 completed the 18-week follow-up. The study population was evenly split between men and women.
In order to participate in the study, patients had to report back pain with a pain intensity rating of at least 3 of 10 on an 11-point numerical rating scale that persisted for at least 12 consecutive weeks. Baseline scores on the scale were 5.6 for the intervention group and 5.8 for the sham group.
People with back pain as a result of a serious medical condition, those who were pregnant or had given birth in the 6 months prior to the study, and those who had received spinal surgery in the last year were excluded.
One participant in the intervention group reported exacerbation of existing low back pain, while two participants in the control group reported transient general musculoskeletal pain.
McAuley and team noted that treating clinicians were not masked to randomization, and outcome measures were self-reported. In addition, because the study was conducted at a single center in Australia, results may not be generalizable to other groups.
This study was funded by the National Health and Medical Research Council of Australia.
McAuley reported relationships with the National Health and Medical Research Council of Australia and the Neuro-Orthopaedic Institute of Australia. Co-authors disclosed several relationships with industry.