Matthew Bagg

Gradual sensorimotor retraining dramatically improves the intensity of pain after 18 weeks, as compared to a sham-based procedure and attention control for people who suffer of chronic lower back discomfort, as a recent randomised clinical trial has demonstrated. The results of the study were reported in JAMA by Matthew Bagg (Neuroscience Research Australia, Sydney, Australia) and others.

According to the research team, “the effects of altered neural processing, which is defined as altering neural networks that control perception about pain as well as function on chronic pain remain unclear”. Therefore, the RESOLVE study sought to assess the impact of a graduated sensory motor retraining program on the severity of pain for people who suffer from chronic low back pain.

Patients suffering from chronic (more than 3 months) non-specific low back discomfort from the primary care or community setting were enrolled in the study.

276 adults were randomly assigned (in the ratio 1:1) to either the procedure of intervention or sham and attention control group delivered by a team of clinicians from a medical research institute located in Sydney, Australia. One participant was randomly selected on December 10 in 2015, while the final one was randomly selected on the 25th of July in 2019. The follow-up phase was completed on the 3rd of February in 2020.

Participants who were randomly assigned to the group of intervention (n= 138) were required to take part in weekly sessions of clinical therapy and at-home training to help them understand and aid them with their movements and physical exercise while suffering from lower back discomfort. In contrast, those who were assigned to the group of control (n= 138) were required to take part in weekly sessions of clinical therapy and at-home training, which required the same amount of time as the intervention, but did not concentrate on education, movement, or physical activities. The control group was comprised of shortwave diathermy and sham-laser that was applied on the back and non-invasive sham brain stimulation.

The main outcome was pain intensity after 18 weeks. This was measured using an 11-point numerical scale (range zero [no pain from 0 [no pain] to 10 (worst pain you can imaginethe worst pain possible) where the between-group minimal clinically significant distinction is one point.

In the 276 patients who were randomly selected (mean of [SD] age 46 [14.3 years; 138, 50%women) 261 (95 percent) had completed follow-up after 18 weeks. The mean intensity of pain measured 5.6 at baseline, and 3.1 over 18 weeks, in the intervention group , and 5.8 at the time of baseline and 4 after 18 weeks with the control group with an estimated average difference of 18 weeks of one point (95 percent confidence interval [CI), -1.5 up to -0.4; p=0.001), favoring the group that received intervention.

In an interview with Spinal News International, Bagg said: “At the center of this study was the realization that retraining our brains can ease back pain.” back pain. The study recognized the progress made over the last 25 years in the way that our brains and the pain interact. We employed specific therapies to address the way that people’s back move as well as how they feel when moving. This was the first major test of this technique and the most exciting part is that we discovered that training how the body and brain communicate could help alleviate lower back discomfort.”