Individualized treatment of back pain leads to an increased effect compared to standard therapies

Individualized treatment of back pain leads to an increased effect compared to standard therapies

If therapy for chronic back pain is tailored specifically to the individual needs of the patient, the chances of success are far greater than with conventional forms of treatment. Accompanied by a psychotherapeutic procedure in the form of cognitive behavioral therapy, the pain can be alleviated even more effectively. This is the result of a meta-analysis by the Goethe University Frankfurt, in which data from over 10,000 patients were brought together and analyzed. It can be concluded from the study that multimodal therapies should be more strongly promoted in the German health system in accordance with the national care guidelines.

Lack of exercise, poor posture, overexertion, constant stress at work or at home – back pain is a widespread ailment with many causes. For a significant proportion of those affected, the symptoms are chronic, meaning they persist for a long time or occur again and again. Sports and exercise therapies under supervision can provide relief. Common treatment methods include physiotherapy and strength and stability exercises. But how can the therapy be as successful as possible? Which approach is most effective in relieving pain? A meta-analysis from Goethe University Frankfurt recently published in the Journal of Pain has provided new insights.

The starting point was data from 58 randomized controlled trials (RCTs) with over 10,000 patients with chronic low back pain worldwide. First, the data relevant to the topic was filtered out of the original manuscripts and then evaluated in groups. When evaluating this data, the researchers examined, on the one hand, whether and to what extent standard forms of treatment and individualized treatments differ in results. “Individualized” means that it is a type of personal coaching in which therapists specifically address the potential and needs of each patient and decide together with them what their therapy should look like.

The study concluded that individualized treatment of chronic back pain resulted in a significantly increased effect compared to standard exercise therapies. The success rate in pain relief was 38 percent higher than standard treatment.

The greater effort for individual treatment is worth it because the patients benefit from it to a clinically relevant extent.”

Dr. Johannes Fleckenstein, lead author, Institute for Sports Science at the Goethe University Frankfurt

However, the study went further. In addition to the standard and individualized treatment methods, the research team in Frankfurt compared a third group of treatment methods. In this group, individualized training sessions were combined with cognitive behavioral therapy (CBT). This procedure – a type of talk therapy – is based on the assumption that negative thoughts and behaviors surrounding pain tend to make it worse. Through CBT, pain patients learn to change the way they deal with it. You will no longer be afraid to move or be taught pain management tactics. This makes them realize that they are by no means helpless. But what does psychotherapeutic support through CBT actually contribute to the success of the treatment? Analysis of the data revealed the following: When combining individualized approach and CBT, the success rate in terms of pain relief was an impressive 84 percent higher than with standard treatment. Combined therapy, also known as multimodal therapy, led to by far the best result.

Fleckenstein sees the study as “an urgent appeal to health policymakers” to promote combination therapies in both patient care and reimbursement. "Compared to other countries, such as the USA, we are doing relatively well in Germany. For example, we write fewer prescriptions for strong narcotics such as opiates, which can also contribute to the chronicity of pain, and inaccurate surgical indications are still very high. According to Fleckenstein, this is also due to economic incentives, i.e. the relatively high remuneration for such interventions. The situation is different for organizations that work in the field of pain therapy are, he says. Although these are not unprofitable, they are not a cash cow for investors either. In his view, it is important to improve the economic conditions here. After all, pain therapy saves a lot of money in the long term in terms of health economics, whereas tablets and operations rarely lead to medium and long-term pain relief.

Source:

Goethe University Frankfurt am Main

Reference:

Fleckenstein, J., et al. (2022) Individualized training for chronic non-specific back pain: A systematic review with meta-analysis on the effects of training alone or in combination with psychological interventions on pain and disability. Diary of Pain. doi.org/10.1016/j.jpain.2022.07.005.

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