Graded sensorimotor retraining significantly improves pain intensity at 18 weeks, compared to a sham procedure and attention control, for those suffering from chronic low back pain, a new randomised clinical trial has shown. The findings of the trial were published in JAMA by Matthew Bagg (Neuroscience Research Australia, Sydney, Australia) et al.
According to the researchers, “the effects of altered neural processing, defined as altering neural networks responsible for perceptions of pain and function, on chronic pain remains unclear”. As such, the RESOLVE trial sought to estimate the effect of a graded sensorimotor retraining intervention on pain intensity in people with chronic low back pain.
Those with chronic (more than three months) non-specific low back pain from primary care and community settings were recruited for the trial.
A total of 276 adults were randomised (in a 1:1 ratio) to the intervention or sham procedure and attention control groups delivered by clinicians at a medical research institute in Sydney, Australia. The first participant was randomised on 10 December, 2015, and the last was randomised on 25 July, 2019. Follow-up was completed on 3 February, 2020.
Participants randomised to the intervention group (n= 138) were asked to participate in 12 weekly clinical sessions and home training designed to educate them about and assist them with movement and physical activity while experiencing lower back pain. Meanwhile, participants randomised to the control group (n= 138) were asked to participate in 12 weekly clinical sessions and home training that required similar time as the intervention but did not focus on education, movement, and physical activity. The control group included sham laser and shortwave diathermy applied to the back and sham non-invasive brain stimulation.
The primary outcome was pain intensity at 18 weeks, measured on an 11-point numerical rating scale (range, 0 [no pain] to 10 [worst pain imaginable]) for which the between-group minimum clinically important difference is one point.
Among 276 randomised patients (mean [SD] age, 46 [14.3] years; 138 [50%] women), 261 (95%) completed follow-up at 18 weeks. The mean pain intensity was 5.6 at baseline and 3.1 at 18 weeks in the intervention group and 5.8 at baseline and 4 at 18 weeks in the control group, with an estimated between-group mean difference at 18 weeks of −1 point (95% confidence interval [CI], −1.5 to −0.4; p=0.001), favouring the intervention group.
Speaking to Spinal News International, Bagg said: “At the heart of this trial was the discovery that retraining our brain can help with lower back pain. The study recognised 25 years of progress in how the brain and pain work together. We used specific treatments to target how people’s back move and how they feel when they’re moving. This trial was the first large test of this approach and what’s promising is we found that retraining how the brain and the body communicate can help lower back pain.”