Retraining brain and body communication underpins novel pain treatment

People challenged with chronic back pain have been given hope thanks to a first of its kind pain treatment, trialled by researchers at Neuroscience Research Australia (NeuRA), UNSW Sydney and collaborating universities, that retrains how the back and the brain communicate.

A novel approach to chronic back pain

The new treatment, known as ‘graded sensorimotor retraining’, challenges traditional treatments for chronic back pain, such as drugs, spinal manipulation, injections, surgery and spinal cord stimulators, by viewing long-standing back pain as a modifiable problem of the nervous system rather than a disc, bone or muscle problem.

Professor James McAuley from NeuRA and UNSW’s School of Health Sciences explained that people with back pain are often told their back is vulnerable and needs protecting.

“This changes how we filter and interpret information from our back and how we move our back. Over time, the back becomes less fit, and the way the back and brain communicate is disrupted in ways that seem to reinforce the notion that the back is vulnerable and needs protecting. The treatment we devised aims to break this self-sustaining cycle,” he said.

“Sensorimotor retraining alters how people think about their body in pain, how they process sensory information from their back and how they move their back during activities.”

Professor James McAuley
Professor James McAuley, Lead author of the study from NeuRA and UNSW’s School of Health Sciences

What the trial found

The trial, carried out at NeuRA, divided 276 participants into two groups: one undertook a 12-week course of sensorimotor retraining and the other received a 12-week course of sham treatments designed to control for placebo effects, which are common in low back pain trials.

“What we observed in our trial was a clinically meaningful effect on pain intensity and a clinically meaningful effect on disability. People were happier, they reported their backs felt better and their quality of life was better. It also looks like these effects were sustained over the long term; twice as many people were completely recovered. Very few treatments for low back pain show long-term benefits, but participants in the trial reported improved quality of life one year later,” Prof. McAuley said.

“If you compare the results to studies looking at opioid treatment versus placebo, the difference for that is less than one point out of 10 in pain intensity, it’s only short term and there is little improvement in disability. We see similar results for studies comparing manual therapy to sham or exercise to sham”.

The study, funded by the Australian National Health and Medical Research Council, has been published in the Journal of the American Medical Association.

The study authors say that more research is needed to replicate these results and test the treatment in different settings, populations and in other chronic pain states that show similar disruption within the nervous system. They are optimistic about rolling out a training package to bring this new treatment to clinics and have enlisted partner organisations to start that process.

Once the new treatment is available via trained physiotherapists, exercise physiologists and other clinicians, which Prof. McAuley hopes to occur in the next six to nine months, people with chronic back pain should be able to access it at a similar cost to other therapies offered by those practitioners.