Personalising treatment for back pain, such as by addressing sleep and stress issues, can greatly improve outcomes and reduce disablement, according to new Irish research.
Most treatments for back pain have little or no impact but a study by University of Limerick scientists says there may be cause for more optimism.
They enrolled 200 people in Co Mayo in a trial and found those who received personalised treatment, which specifically matched their health needs, fared better than those who received similar care in a non-personalised manner.
Even though the personalised treatment involved only five treatments on average, those who received it were significantly less disabled when followed up with a year later.
In the trial, patients with back pain received personalised treatment, known as cognitive functional therapy, according to their own needs. In some cases the emphasis was on physical factors such as strength and fitness, while in other cases the emphasis was more on non-physical factors such as stress levels or sleep.
In all cases, the fact that back pain can be linked to both physical and non-physical factors was explained to people.
“Right now, nobody can say any particular treatment will cure back pain,” explained principal investigator Dr Kieran O’Sullivan. “However, this trial - in line with some other recent trials internationally - highlights two important aspects; first, that back pain treatment likely requires us to address both physical and non-physical factors, even though most treatment currently overwhelmingly focuses only on the physical factors; and secondly, that there might be value in better tailoring treatments according to the needs of patients, so that they get the treatment they need, rather than what any particular clinician feels comfortable doing.”
Fundamental change
Dr O’Sullivan, a senior lecturer in physiotherapy at UL, said it has been clear for decades that back pain is influenced by not only physical factors, such as strength, posture and flexibility, but also psychological factors such as worries and mood, and lifestyle factors such as sleep and fitness.
Back pain is the most costly and disabling health condition in the world, with costs exceeding that of cancer and diabetes combined.
Dr O’Sullivan said a fundamental change was needed in how clinicians are trained to treat people with pain, and how services are offered to them. “Unfortunately right now, it is often easier for people with back pain to get access to ineffective treatments, even when they are more expensive than good treatments.”
The study, published in the British Journal of Sports Medicine, was funded by the Irish Research Council and conducted in conjunction with the HSE and with international collaborators at Curtin University, Perth, Australia.
