Researchers have found that combining education to help patients think differently about chronic spinal pain with an exercise program that increasingly introduced movements patients feared or avoided was significantly better than usual care for the condition.
Researchers, led by Anneleen Malfliet, of Vrije Universiteit Brussels in Belgium, conducted a randomized clinical trial of patients with chronic spinal pain. Their findings were published Monday in the Journal of American Medical Association’s Neurology.
Currently, nonsurgical treatment for nonspecific chronic spinal pain includes nonsteroidal anti-inflammatory drugs, joint manipulation, acupuncture and exercise therapy. But the researchers noted they “seem to have limited benefits.”
The authors noted patients with chronic spinal pain can have thoughts of pain associated with poor treatment, including include fear of movement, hypervigilance and pain catastrophizing.
They studied 120 patients with chronic nonspecific spinal pain in two outpatient hospitals in Ghent and Brussels in Belgium from Jan. 1, 2014, to Jan. 30, 2017, with followups at three, six and 12 months. One group received pain neuroscience education and cognition-targeted motor control training while the other one received basic education on back and neck pain and general exercise therapy. The median age in each group was about 40 years old.
The researchers found there was a 50 percent improvement in pain in the specific program, and it was maintained at long-term follow-up.
“Significant clinical improvements without detectable changes in brain gray matter morphologic features calls into question the relevance of brain gray matter alterations in this population,” the researchers wrote.
The researchers noted there is a need for different treatment methods.
“Our results emphasize the need for a shift from a biomedical approach toward a biopsychosocial approach that combines pain neuroscience education with cognition-targeted motor control training for people with nonspecific chronic spinal pain,” the researchers wrote. “Clinicians should integrate modern pain neuroscience into the management of nCSP, rcspather than focusing on a possible biomedical origin of pain.”
And the researchers suggested additional research should be conducted to see if broader chronic pain treatments can be improved.
“Further research should investigate if the combination of pain neuroscience education with cognition-targeted exercises is also effective in subgroups, such as individuals with chronic whiplash-associated disorders, and other populations with chronic pain, such as chronic knee osteoarthritis and postcancer pain,” the researchers concluded.