RESOLVE Trial for Chronic Low Back Pain - NeuRA
A modern treatment that trains both the brain and the body has shown important effects on pain and disability in a paper just published in Journal of the American Medical Association.
- Training both the brain and the body together
- Reductions in pain intensity and disability that were clinically and significantly better than the sham control group
- Improvements present at the one year follow up
People challenged with chronic back pain respond well to a new treatment approach that focuses on training the body and the brain together, a randomised control trial run by researchers at UniSA, UNSW and several other Australian and European Universities, has just shown.
This modern approach challenges traditional treatments for chronic back pain such as drugs, manual therapy techniques, surgery and insertion of stimulation devices, by viewing chronic back pain as a modifiable problem of the nervous system, not a structural problem of the lower back.
The study, carried out in Sydney at Neuroscience Research Australia, divided 276 participants into two groups: one who were put through a 12-week course of this new ‘education and sensorimotor training’ approach, and the other who received sham treatments specifically designed to control for common effects in back pain trials.
Their results are published today in the Journal of the American Medical Association, and show that the new treatment offered reductions in pain intensity and disability that were clinically and statistically significantly better than those in the sham group. Improvements were still present at the one year follow up. Reality Health Scientific Advisor Professor Lorimer Moseley AO, Bradley Distinguished Professor at UniSA, who is recognised internationally for his innovative approaches to treating chronic pain conditions, noted the excitement in the research team:
“These effects are better than those seen in placebo-controlled opioid, manual treatment or exercise programs trials. We did not expect to see such a clear and sustained difference between the groups - a clinically meaningful effect on pain intensity and disability; their quality of life was better and the treatment is cost-effective. To see these long term benefits raises the stakes for pursuing better outcomes for people challenged by chronic back pain”
UniSA’s Associate Professor Tasha Stanton, also involved in the trial, noted that ‘This is the first new treatment of its kind for back pain that has been tested against a credible placebo treatment. That’s important because clinical trials that compare to usual care or waiting lists don’t control for potentially powerful non-specific effects of a treatment’.
Professor Moseley identified that the potential impact of this work is substantial “Considering that back pain has exerted a massive Global Disability Burden for the last 30 years, we need to use the very latest discoveries in neuroscience to keep devising more effective treatments for this problem. This is a big step in the right direction”.
How this new treatment works
Professor Moseley said ‘this treatment, which includes specially designed education modules and methods and sensorimotor retraining, 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 aims to achieve three goals: 1. to align patient understanding with the latest scientific understanding about what causes chronic back pain; 2. to normalise the way the back and the brain communicate with each other, and 3. to gradually retrain the body and the brain back to a normal protection setting and a resumption of usual activities.
Professor James McAuley from UNSW, described the new treatment “People with back pain are often told their back is vulnerable and needs protecting. 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.”
Professor Ben Wand of Notre Dame University, the clinical director on the trial, emphasised that by using a program of sensorimotor training, patients can see that their brain and back are not communicating well, but can also experience an improvement in this communication. We think this gives them confidence to pursue an approach to recovery that trains both the body and the brain.”
Training the body and the brain
Traditional medical and physical therapies have concentrated on fixing something in your back, injecting a disc, loosening up the joints or simply ‘increasing core strength’. The problem is, there is little evidence that these things actually cause chronic back pain.
Traditional psychological therapies focus on accepting that pain is unchangeable and learning to live well despite your back pain. What makes this approach different, according to the international team behind the trial, is that it trains the whole system – how people understand their back pain, how the back and brain communicate, how the back is moved and loaded, and the strength and fitness of the back. ‘This study adds to other discoveries of the last 20 years that show that chronic pain is changeable but that it takes both new understanding and a period of retraining to change it’ said Professor Moseley.
The study authors say that more research is needed to replicate these results and to test the treatment in different settings and populations. They also want to test their approach in other chronic pain states that show similar disruption within the nervous system. They are optimistic about rolling out a training package to bring this new treatment to clinics and have enlisted partner organisations to start that process.
Once the new treatment is available via trained physiotherapists, exercise physiologists and other clinicians – Professor McAuley hopes this to occur in the next six to nine months – people with chronic back pain should be able to access it at a similar cost to other therapies offered by those practitioners.
