|Rehab Clinician (OT/PT)|
OBJECTIVE: To assess the effect of a pain neurophysiology education (PNE) program plus therapeutic exercise (TE) for patients with chronic low back pain (CLBP).
DESIGN: Single-blind randomized controlled trial.
SETTING: Private clinic and university.
PARTICIPANTS: Patients with CLBP for =6 months (N=56).
INTERVENTIONS: Participants were randomized to receive either a TE program consisting of motor control, stretching, and aerobic exercises (n=28) or the same TE program in addition to a PNE program (n=28), conducted in two 30- to 50-minute sessions in groups of 4 to 6 participants.
MAIN OUTCOMES MEASURES: The primary outcome was pain intensity rated on the numerical pain rating scale which was completed immediately after treatment and at 1- and 3-month follow-up. Secondary outcome measures were pressure pain threshold, finger-to-floor distance, Roland-Morris Disability Questionnaire, Pain Catastrophizing Scale, Tampa Scale for Kinesiophobia, and Patient Global Impression of Change.
RESULTS: At 3-month follow-up, a large change in pain intensity (numerical pain rating scale: -2.2; -2.93 to -1.28; P<.001; d=1.37) was observed for the PNE plus TE group, and a moderate effect size was observed for the secondary outcome measures.
CONCLUSIONS: Combining PNE with TE resulted in significantly better results for participants with CLBP, with a large effect size, compared with TE alone.
This result is similar to prior studies of multimodality pain management. With the opioid crisis, it is important that information like this get both to physicians that treat pain and to people who have pain. These approaches appear more beneficial than chronic opioid therapy!
As primary care physician, I find chronic low back pain is a relatively frequent condition and sometimes very difficult to manage. This article provides new approaches and useful techniques in the management of this disorder which can be very useful for Primary care practitioners.
There was a small number of subjects and a short follow-up. The outcome of therapeutics for CLBP should be measured for longer than six months.
As a Orthopaedic and Sports PT, I find the results of this study provide added support for the efficacy of pain neuroscience education and exercise in patients with chronic pain conditions, including LBP.