Chronic lower back pain can be improved with a change of mindset rather than physio, study finds

Focusing on a patient’s exercise preferences can help people with lower back pain live a more active life – without the need for physio, research has found. 

Treatment options for chronic lower back pain have long been limited and offer only moderate shot-lived benefits. 

Whilst clinical guidelines for the debilitating condition recommend that first-line treatment should include reassurance about a patient’s ability to self-manage symptoms – in practice this is often overlooked. 

Now experts have shown that focusing on a patient’s beliefs about their prognosis and encouraging them to do more physical activity of their choosing could be as beneficial as traditional physio, if not more. 

A trial involving more than 1,600 patients with chronic lower back pain found that a form of therapy, called enhanced transtheoretical model intervention (ETMI), improved patients’ overall function in less time than physio.

Typically, physiotherapy for lower back pain involves a combination of exercise therapy, education, movement and things like acupuncture or hot and cold therapy. 

By contrast, ETMI is a self-management approach that prioritises overcoming unhelpful beliefs about the condition, and encouraging leisure-time physical activity. 

For some people, lower back pain is a one-off event, caused by overexertion or injury, that improves with time but for others it can cause serious long-term issues.

The new study, published in the journal JAMA Network Open, focused of ETMI which works by addressing the causal mechanisms  of chronic back pain. 

The researchers collected data on patients’ level of physical activity – categorised as none, one to two times a week a more than three times – number of physio appointments, and use of ETMI at baseline and once treatment was completed. 

Participants were also asked to monitor how their function level, pain and fear avoidance beliefs about physical activity changed over the course of treatment. 

Function was measured on a linear scale of 0-100, with a higher score indicating greater function. 

Similarly, pain intensity over the past 24 hours was ranked from 0-10, with 10 indicating severe pain.  

Of the 1,624 patients, 83 per cent were given ‘usual care’ whilst 259 patients received ETMI. 

Patients who didn’t receive ETMI were given what their GP surgery recommended or what they chose from local services – which could include a combination of pain medication, self-management tips and physiotherapy. 

The team found that those receiving ETMI needed fewer treatment sessions than patients receiving usual care, and experienced greater improvements in function and fear-avoidance beliefs. 

Results suggested that ETMI was more effective than usual care in reducing activity limitation – with patients exposed to brisk walking sessions during ETMI therapy – caused by lower back pain. 

This was also true for patients who had been diagnosed with depression and/or anxiety.  

However, across all groups, the researchers noted there were no significant differences in pain levels – likely due to the fact that the intervention ‘targets patients’ beliefs and activity patterns rather than directly addressing pain symptoms.’ 

They concluded: ‘Whilst the transition from a clinician-managed approach to back pain that focuses of specific diagnoses and treatments involving targeted exercises towards a model that prioritises patient self-management may be challenging, wider adoption could contribute to more sustainable musculoskeletal care.’