Nearly 65 million Americans say they have recently suffered from back pain.
A study from Goethe University Frankfurt found that a combined approach works best.
Back pain is a common condition that has many causes, including poor posture, overexertion, constant stress at work or home, lack of exercise, and poor posture. For a considerable number of patients, the symptoms are chronic, that is, they last a long time or recur repeatedly. However, wearing and exercising therapy, when done correctly, can provide relief.
Physical therapy, as well as strength and stability exercises, are common treatment options. But how can the treatment be as effective as possible? Which method is most effective in reducing pain? A recent meta-analysis published in the pain diary by Goethe University Frankfurt revealed new insights.
The researchers started with data from 58 randomized controlled trials (RCTs) involving more than 10,000 people with chronic low back pain across the world. The relevant data from the original manuscripts was first filtered and then analyzed by groups. When analyzing this data, the researchers looked at whether and how conventional forms of therapy and individualized treatment varied in terms of outcomes. “Individualized” refers to a kind of personal coaching where therapists precisely target the needs and potentials of each patient and collaborate with them to choose the course of their treatment.
People who sit a lot and don’t exercise often develop back pain. Credit: Markus Bernards for Goethe University Frankfurt
According to research, individualized therapy for chronic back pain has had a much greater impact than conventional exercise therapies. The success rate for pain relief was 38% higher than with conventional therapy.
“The greater effort required for individual treatment is worth it because patients benefit to a clinically important extent,” says lead author Dr. Johannes Fleckenstein from the Institute of Sports Science at Goethe University. from Frankfurt.
However, the study went even further. The Frankfurt research team compared a third group of treatment methods to standard and individualized methods. In this group, individualized training sessions were combined with cognitive behavioral therapy (CBT). This procedure – a type of talk therapy – is based on the assumption that negative thoughts and behaviors surrounding pain tend to exacerbate it. Through CBT, pain patients learn to change the way they manage pain.
They stop being afraid to move or learn tactics to deal with the pain. This makes them realize that they are in no way powerless. But what does CBT psychotherapeutic support actually contribute to treatment success? Analysis of the data revealed the following: when an individualized approach and CBT were combined, the success rate in terms of pain relief was 84% higher than with standard treatment. Combination therapy, also called multimodal therapy, thus led to the best result by far.
Fleckenstein sees the study as “an urgent call for public health policy” to promote combination therapies both in terms of patient care and remuneration. “Compared to other countries, such as the United States, we are in a relatively good position in Germany. For example, we are issuing fewer prescriptions for strong narcotics like opiates. But the number of unnecessary X-rays, which, by the way, can also contribute to the chronicity of pain, and inaccurate indications for surgery are still very high.
This is also due, according to Fleckenstein, to economic incentives, i.e. the relatively high remuneration of such interventions. The situation is different for organizations working in pain therapy, he says. Although they are not unprofitable, they are not a cash cow for investors either. According to him, it is important here to improve the economic conditions. After all, pain therapy saves a lot of money in the long term when it comes to health economics, whereas tablets and operations rarely lead to medium and long term pain relief. .
Reference: “Individualized exercise in chronic nonspecific low back pain: a systematic review with meta-analysis on the effects of exercise alone or in combination with psychological interventions on pain and disability” by Johannes Fleckenstein, Philipp Floessel, Tilman Engel, Laura Krempel, Josefine Stoll, Martin Behrens and Daniel Niederer, July 29, 2022, pain diary.
DOI: 10.1016/j.jpain.2022.07.005
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