Low back pain is one of the most common and difficult-to-treat medical complaints among adults. Treatment often includes physical therapy, but new research shows that a hands-off educational and behavioral approach to pain management works just as well.
Researchers say people in the study who suffered from short-duration low back pain responded well to counseling programs that explored their attitudes toward pain and urged them to exercise and resume routine activities despite their discomfort.
"This approach targets erroneous beliefs about back pain, like the belief that exercise is bad because it hurts," study researcher Krysia Dziedzic, PhD, of Keele University in Staffordshire, England, tells WebMD. "It encourages people to stay active and teaches them how to better manage pain when they have it."
Dziedzic, researcher Elaine Hay, and colleagues followed 400 patients with low back pain of unknown origin for a year.
Half of the patients were treated with a standard course of physical therapy that included spinal manipulation. This included up to seven 20-minute treatment sessions. The other half got the two-day educational and behavioral therapy course, which was supplemented by tutoring with the use of a treatment log.
None of the patients had had back pain for more than three months, and both types of therapy were delivered by physical therapists.
The researchers reported that clinical outcomes were the same at three months and 12 months for patients in both treatment groups. A total of 68 percent of patients in the behavioral group reported that they were much better or completely better one year later, compared with 69 percent of patients in the manual physical therapy group.
The study is published in the June 11 issue of The Lancet.
The findings show that manual therapy is not essential as an initial treatment for patients with low back pain of only a few weeks' or months' duration, Hay says.
"The pain-management package was delivered in fewer treatment sessions, resulted in fewer referrals to secondary care than the traditional approach, and might be an efficient first-line approach to care for patients with low back pain."
Targeted Treatment a Goal
In an accompanying editorial, researchers Paul G. Shekelle, MD, PhD, and Anthony Delitto, PhD, wrote that different types of patients may benefit from different types of treatment.
"There was a one-size-fits-all approach to intervention in this study, as indeed there is in almost all back pain treatment," Shekelle tells WebMD. "The hope is that we will soon be able to identify subgroups of patients who will respond better to one treatment or another."
In a study reported late last year, Delitto and colleagues were able to identify clinical characteristics that predicted whether or not low back pain patients would respond to spinal manipulation.
Shekelle says a major limitation of the latest study is that the researchers measured pain management at three and 12 months but had no information about differences in pain before this.
He adds that the clinical evidence shows that spinal manipulation acts as a nondrug pain reliever to lessen back pain temporarily.
"Most patients get better over time, but the question is, 'How fast do they get better?'" Shekelle says.
"It is similar to having a really bad sore throat and having the doctor tell you that you will get better in a week or so, but that you can take a pill to feel better in a few days. Most people will take the pill, even though they know the long-term outcome will be the same no matter what they do."
SOURCES: Hay, E.M. The Lancet, June 11, 2005; vol 365: pp 2024-2030. Krysia Dziedzic, PhD, senior lecturer in physiotherapy, Keele University, Staffordshire, England. Paul Shekelle, MD, PhD, MPH, associate professor of medicine, UCLA School of Medicine; staff physician, VA Medical Center, West Los Angeles; director, Southern California Evidence-Based Practice Center, RAND Corporation.