A randomized controlled experiment conducted by academics at UNSW Sydney, Neuroscience Research Australia (NeuRA), and several other Australian and European universities has given people suffering from chronic back pain hope.

In a report that was published today in the Journal of the American Medical Association, the findings of the research project that was supported by the Australian National Health and Medical Research Council (NHMRC) were discussed.

The research was conducted at NeuRA, and it involved 276 participants who were split into two groups: one group received a 12-week course of sham treatments designed to control for placebo effects, which are common in low back pain trials; the other group underwent a 12-week course of sensorimotor retraining.

Sensorimotor retraining, according to Professor James McAuley of UNSW’s School of Health Sciences and NeuRA, modifies how people perceive their bodies in pain, how they interpret sensory data from their backs, and how they move their backs when engaging in activities.

“What we observed in our trial was a clinically meaningful effect on pain intensity and a clinically meaningful effect on disability,” the authors write in the their study.

People indicated that their quality of life had improved, they were happier, and their backs felt better. 

By viewing persistent back pain as a modifiable problem of the nervous system rather than a disc, bone, or muscle problem, the new treatment challenges conventional treatments for chronic back pain, such as drugs and treatments that focus on the back, such as spinal manipulation, injections, surgery, and spinal cord stimulators.

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

Back pain has been the leading contributor to the global disability burden for the past 30 years, and this is the first novel treatment of its sort that has been compared to a placebo.

How does it work?

According to Prof. McAuley, the treatment is based on studies showing that persons with chronic back pain exhibit distinct neural system behaviors than those who have just sustained a lower back injury.

“People with back pain are often told their back is vulnerable and needs protecting. This changes,” according to the researcher, “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.”

“This treatment, which includes specially designed education modules and methods and sensorimotor retraining,” according to Professor Lorimer Moseley AO, Bradley Distinguished Professor at the University of South Australia, “aims to correct the dysfunction we now know is involved in most chronic back pain and that’s a disruption within the nervous system.”

“The disruption results in two problems: a hypersensitive pain system and imprecise communication between the back and the brain.”

The treatment has three objectives. The first step is to match patient perceptions with the most recent scientific understanding of what causes chronic back pain. The second step is to restore normal communication between the back and the brain, and the third is to gradually retrain the body and the brain to return to a normal protective setting and resume normal activities.

The clinical director of the trial, Professor Ben Wand of Notre Dame University, emphasized that by utilizing a program of sensorimotor training, patients can not only recognize that their brain and back are not communicating correctly, but also experience an improvement in this connection. 

“We think this gives them confidence to pursue an approach to recovery that trains both the body and the brain,” he added.

Training the brain and body

Traditional treatments focus on repairing a problem in your back, injecting a disc, easing the joints, or building up the muscles. According to Prof. McAuley, what distinguishes sensorimotor retraining from other approaches is that it considers the entire system, including how people perceive their backs, how their brains and backs interact, how their backs move, and how fit their backs are.

More study, according to the study’s authors, is required to verify these findings and test the treatment in various populations and settings. They also intend to test their strategy in other chronic pain conditions that exhibit similar nerve system disturbance. They have enlisted partner organizations to begin the process of rolling out a training package to introduce this novel treatment to clinics and are optimistic about doing so.

People with chronic back pain should be able to access the new treatment at a similar cost to other therapies offered by those practitioners once it is available through trained physiotherapists, exercise physiologists, and other clinicians, which Prof. McAuley hopes will happen within the next six to nine months.

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