Back pain treatment: 84% increase in success rate

Lack of exercise, poor posture, overwork, constant stress at work or at home – back pain is a widespread condition with multiple causes. For a significant number of patients, the symptoms are even chronic, that is to say persistent for a long time or recurrent. Sports therapies and instructed exercise can provide relief. Common treatment methods include physical therapy as well as strength and stability exercises. But how can therapy be as effective as possible? Which approach is most effective in relieving pain? A meta-analysis from Goethe University Frankfurt, published recently in the Journal of Pain, has provided new insights.

The starting point was data from 58 randomized controlled trials (RCTs) involving more than 10,000 patients worldwide with chronic low back pain. First, topic-relevant data was filtered from the original manuscripts and then assessed in groups. When evaluating these data, the researchers examined on the one hand whether and to what extent standard forms of treatment and individualized treatments differ in terms of outcome. “Individualized” means that there is a kind of personal coaching, where therapists specifically target the potentials and requirements of each patient and decide together with them what their therapy should look like.

The study concluded that individualized treatment of chronic back pain resulted in a significantly increased effect compared to standard exercise therapies. The success rate in pain relief was 38% higher than standard treatment. “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 the psychotherapeutic accompaniment by CBT really contribute to the success of the treatment? 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. .

Publication: Johannes Fleckenstein, Philipp Floessel, Tilman Engel, Laura Krempel, Josefine Stoll, Martin Behrens, Daniel Niederer. Individualized exercise in chronic nonspecific low back pain: a systematic review with meta-analysis of the effects of exercise alone or in combination with psychological interventions on pain and disability. The Journal of Pain (2022)

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Caption: People who sit a lot and don’t exercise often develop back pain. Credits: Markus Bernards for Goethe University Frankfurt

Further information :

Dr Johannes Fleckenstein

Sports Medicine and Exercise Physiology

Institute of Sports Sciences

Goethe University Frankfurt

/Public release. This material from the original organization/authors may be ad hoc in nature, edited for clarity, style and length. The views and opinions expressed are those of the author or authors. See in full here.

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