Effect of Graded Sensorimotor Retraining on Pain Intensity in Patients With Chronic Low Back Pain

Abstract

IMPORTANCEThe effects of altered neural processing, defined as altering neural networks responsible for perceptions of pain and function, on chronic pain remains unclear.OBJECTIVE To estimate the effect of a graded sensorimotor retraining intervention (RESOLVE) on pain intensity in people with chronic low back pain. DESIGN, SETTING, AND PARTICIPANTSThis parallel, 2-group, randomized clinical trial recruited participants with chronic (>3 months) nonspecific low back pain from primary care and community settings. A total of 276 adults were randomized (in a 1:1 ratio) to the intervention or sham procedure and attention control groups delivered by clinicians at a medical research institute in Sydney, Australia. The first participant was randomized on December 10, 2015, and the last was randomized on July 25, 2019. Follow-up was completed on February 3, 2020.INTERVENTIONS Participants randomized to the intervention group (n = 138) were asked to participate in 12 weekly clinical sessions and home training designed to educate them about and assist them with movement and physical activity while experiencing lower back pain. Participants randomized to the control group (n = 138) were asked to participate in 12 weekly clinical sessions and home training that required similar time as the intervention but did not focus on education, movement, and physical activity. The control group included sham laser and shortwave diathermy applied to the back and sham noninvasive brain stimulation. MAIN OUTCOMES AND MEASURESThe primary outcome was pain intensity at 18 weeks, measured on an 11-point numerical rating scale (range, 0 [no pain] to 10 [worst pain imaginable]) for which the between-group minimum clinically important difference is 1.0 point. RESULTS Among 276 randomized patients (mean [SD] age, 46 [14.3] years; 138 [50%] women), 261 (95%) completed follow-up at 18 weeks. The mean pain intensity was 5.6 at baseline and 3.1 at 18 weeks in the intervention group and 5.8 at baseline and 4.0 at 18 weeks in the control group, with an estimated between-group mean difference at 18 weeks of −1.0 point ([95% CI, −1.5 to −0.4]; P = .001), favoring the intervention group. CONCLUSIONS AND RELEVANCEIn this randomized clinical trial conducted at a single center among patients with chronic low back pain, graded sensorimotor retraining, compared with a sham procedure and attention control, significantly improved pain intensity at 18 weeks. The improvements in pain intensity were small, and further research is needed to understand the generalizability of the findings.

Identifying body awareness-related brain network changes after Spring Forest Qigong™ practice or P.Volve low-intensity exercise in adults with chronic low back pain: a feasibility Phase I Randomized Clinical Trial

“…Low back pain is a leading cause of disability worldwide. [1][2][3] The lifetime prevalence of low back pain is about 40% with 5-10% of acute pain developing into chronic low back pain (cLBP), defined as having low back pain for longer than 3 months. 4 About 85% of adults with cLBP have non-specific low back pain, where an underlying pathology or a nociceptive contributor cannot yet been identified.…”

Radiotherapy Alone vs Radiotherapy With Concurrent Chemoradiotherapy and Survival of Patients With Low-Risk Nasopharyngeal Carcinoma

“…A recent study 1 reported that patients with low-risk stage II and T3N0M0 cancer who received IMRT alone had the same oncologic outcomes but better long-term quality of life than those who received concurrent chemoradiotherapy. We have 3 concerns about the definition of the truly low-risk NPC.…”

Radiotherapy Alone vs Radiotherapy With Concurrent Chemoradiotherapy and Survival of Patients With Low-Risk Nasopharyngeal Carcinoma

“…The mean survival time provides a global measure and is more statistically efficient and clinically interpretable than the hazard ratio. 3 Using reconstructed individual patientlevel data 4 from Figure 2, A and B, 1 the difference (IMRT alone minus concurrent chemoradiotherapy) in 5-year mean failurefree survival was −1.28 months (95% CI, −3.87 to 1.32 months) and for overall survival, it was −0.71 months (95% CI, −1.81 to 0.40 months). These narrow confidence intervals enhance the decision-making process for treatment selection.…”

“…Additionally, the safety profiles between the 2 groups were reported separately from efficacy comparisons, and the concurrent chemoradiotherapy group had substantially higher grade 3/4 acute and late adverse events compared with IMRT alone (Table 2 in the article). 1 Use of separate summary measures to assess the overall treatment effect is suboptimal because it does not incorporate the relationship between efficacy and toxicity at the individual patient level. An alternative is to construct a composite end point (net clinical benefit) 5 from efficacy and safety outcomes to compare the 2 treatments, which may show that IMRT is superior to concurrent chemoradiotherapy.…”

“…In our prior retrospective propensity-matched cohort study, 5 addition of concurrent chemotherapy to IMRT was not associated with significantly better survival for patients with stage II and T3N0M0 NPC; we did observe that a pretreatment EBV DNA level of 4000 copies/mL or greater was an independent poor prognostic factor. Based on that study, we carried out this clinical trial, 1 which showed that radiotherapy alone was not inferior to concurrent chemoradiotherapy for low-risk patients with NPC.…”