1. This clinical trial, which was randomised, proved that in 276 adults suffering from moderate to severe back pain, chronic back pain Graded sensorimotor retraining dramatically reduced pain intensity after 18 weeks, compared to the sham procedure.

2. This trial was conducted in only one centre, and that one year after treatment the mean improvement in pain intensity was not significantly differed between the treatment and placebo groups. Further research on the grading of sensorimotor retraining to determine the effectiveness of this treatment approach.

Evaluation Rating: 1. (Excellent)

Study Overview: The neural processing mechanisms responsible for chronic pain aren’t well known. Particularly the chronic lower back pain is common with few effective treatments. Gradual sensorimotor retraining is a brand new treatment that seeks to change the way that the brain processes of pain. The clinical trial, which was randomised, examined the effectiveness of this treatment for patients suffering from the moderate or severe condition of chronic lower back pain. Patients were contacted by primary healthcare providers in a medical research institute located in Sydney, Australia, between November 1, 2015 between July 28th, 2015 and July 28th, 2019. Adults aged between 18 and 70 years were enrolled when they had low back discomfort with the intensity of 3/10 or more in an 11-point scale, which lasted for at least 3 consecutive weeks or those suffering from low back discomfort caused by a medical issue or from prior operations were not included. The participants were assigned randomly to either receive a graded sensorsimotor retraining (n= 383)) as well as attention-control through the sham method (n= 38). Primary outcome of the study was average intensity of pain during the previous week, which was measured using the numerical scale of 11 points 18 weeks after randomization. The mean pain intensity increased by 5.6 to 3.1 in the treatment group in comparison with 5.8 up to 4.0 for the group that was in control after 18 weeks (estimated median difference= -1.0 (95 percent C.I. -1.5 to -0.4[95% CI: -1.5 to -0.4]; the pequals 0.001). But after 52 weeks there was no significant difference in estimated mean between the two both groups (EMD: -0.5 [95% 95% CI: -1.1 to 0.1]; p=0.09). In addition, the intervention cohort had significantly higher health and quality of life, based on the EQ-5D-5L survey (EMD: 0.1 points [95 percent C.I: 0.0-0.1]; p =0.02) and diminished impairment (EMD: -2.6 points [95 percent 95% CI: -3.9 to -1.3(p 0.001)). pless than 0.001) after 18 weeks. However there was a significant increase in depression (EMD -0.8 points, 95 percent 95% CI: -2.0 to 0.3(p= 0.16)) the pequals 0.16) and sleepiness (EMD: -1.8 [95% 95% CI: -3.7 to 0.1]; p= 0.06) did not appear to be significantly decreased when in comparison to the control group after 18 weeks following randomization. There were no serious adverse reactions observed in either of the groups. In the end, this study proved that grade-sensorimotor training significantly reduced pain after 18 weeks, compared to a sham-based procedure for adult patients suffering from low to moderate chronic back pain. The only drawback of this study is that treating clinicians as well as physical therapists were not blinded by randomization as they were the ones who provided each treatment group. Furthermore, the study was conducted in a single location that calls to conduct additional research at other locations to verify the findings.

Click here to learn more about the research in JAMA

Important Reading Prognosis for chronic and persistent low-back pain The meta-analysis of the literature

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