Chronic back pain – what to do?

Despite numerous therapeutic approaches in recent decades, many people continue to suffer from this pain without any truly effective solutions having been found to date.
It is becoming increasingly clear that chronic pain is subject to multi-causal influences.
One approach that focuses on biopsychosocial factors and has developed a structured therapy concept is cognitive functional therapy (CFT).
This therapy includes pain categorization, controlled exposure and lifestyle management.
A study called “RESTORE” by Kent and colleagues in the Lancet Journal compared CFT with standard therapy.
Nearly 500 patients were randomly assigned to one of the 12-week therapies and followed for over a year.
Those who received CFT had less pain afterwards and were less limited by their pain.
This effect lasted for over a year and also resulted in lower costs to society.
Although it is not clear what exactly the standard therapy looked like, it can be assumed that it followed a modern structured approach.
This is also reflected in the more positive expectations regarding the therapies in the CFT group.
It is now well established that expectations can influence the outcome of therapy.
Even if the people were not completely pain-free, most of them were significantly more satisfied after the therapy.
This shows once again that pain and suffering are not the same thing.
The RESTORE study was a phase 3 trial conducted in Australia using a randomized controlled design with three arms and parallel groups.
The study involved 20 primary care physiotherapy clinics.
The study involved adults aged 18 years and older who had been suffering from lower back pain for more than three months, with moderate limitation of physical activity due to the pain.
Exclusion criteria included severe spinal conditions (such as fractures, infections or cancer), conditions limiting physical activity, recent pregnancy or childbirth, insufficient English language skills to understand the study materials, allergies to tape, planned surgery within three months or unwillingness to travel to the study site.
Participants were randomly assigned in a 1:1:1 ratio to one of three groups: usual care, cognitive function therapy (CFT) alone, or CFT with biofeedback.
The primary outcome was activity limitation after 13 weeks, as measured by the Roland Morris Disability Questionnaire.
Economic outcomes were also assessed in terms of quality-adjusted life years (QALYs).
Both intervention groups received up to seven treatment sessions over 12 weeks and a booster session after 26 weeks.
Neither the physiotherapists nor the patients were blinded to the interventions. The study was registered with the Australian New Zealand Clinical Trials Registry. Results: Between October 23, 2018 and August 3, 2020, 1011 patients were screened for eligibility.
After excluding 519 ineligible patients, 492 participants were randomly assigned, 164 to CFT only, 163 to CFT plus biofeedback and 165 to usual care.
Both intervention groups showed greater efficacy in activity limitation at 13 weeks and similar effect sizes at 52 weeks compared to usual care.
They also showed improvements in QALYs and were associated with significantly lower societal costs compared to usual care. Evaluation: CFT showed significant and sustained improvements for individuals suffering from chronic, debilitating low back pain at a significantly lower societal cost compared to usual care.In psychosomatic osteopathy, we are broadening the focus and integrating top-down and bottom-up treatment approaches, resulting in new techniques. Kent P, Haines T, O’Sullivan P, Smith A, Campbell A, Schutze R, Attwell S, Caneiro JP, Laird R, O’Sullivan K, McGregor A, Hartvigsen J, Lee DA, Vickery A, Hancock M; RESTORE trial team.
Cognitive functional therapy with or without movement sensor biofeedback versus usual care for chronic, disabling low back pain (RESTORE): a randomized, controlled, three-arm, parallel group, phase 3, clinical trial.
Lancet.
2023 Jun 3;401(10391):1866-1877.
doi: 10.1016/S0140-6736(23)00441-5.