- A systematic review and meta-analysis in The Journal of Pain found that those with chronic low back pain who followed a more personalized approach to care had significantly higher success rates compared to those who followed a general exercise plan.
- Researchers also found that combining tailored training sessions with cognitive behavioral therapy (CBT) resulted in the highest success rate for back pain relief.
When it comes to occasional back pain—a condition about 65 million Americans experience, according to one estimate—standard treatments typically include over-the-counter painkillers and anti-inflammatories, paired with alternating heat and cold to bring relief. But with chronic pain, which affects about 8 percent of those with back issues, a more individualized approach can bring better results, according to a new systematic review and meta-analysis in The Journal of Pain.
Reviewing 58 studies representing more than 10,000 participants with chronic low back pain, researchers looked at the effects of generalized exercise plans compared to tailored approaches that included personal coaching. Effectiveness of these approaches was based on self-reporting—participants rated their pain on a standard scale—as well as evidence of disability. Researchers, for example, noted if participants took off time from work due to back pain. What made something successful was less disability and lower ratings on the pain scale.
The study revealed that pain relief for those who had a more tailored approach to care was significantly higher, with participants experiencing 38 percent higher success rates than standard treatment. This type of coaching involves a physical therapist looking at the requirement of each patient and designing a treatment plan geared toward the potential causes of their back problems, often implementing specific exercises to help address the pain.
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In part, these outcomes are better because a more individualized approach requires more effort, lead author Johannes Fleckenstein, Ph.D., researcher at the Institute of Sport Sciences at Goethe University Frankfurt told Bicycling.
With that in mind, the researchers considered a third treatment method that would boost patient effort even more: combining individualized training sessions with cognitive behavioral therapy (CBT) that addresses negative thoughts and behaviors that contribute to pain.
“The success rate with CBT and guided exercise was especially notable,” said Fleckenstein. “That brought the [success] rate to an impressive 84 percent compared to standard treatment.” He added that the next step in the research is to determine if these results can hold for long-term relief from chronic back pain.
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Previous studies already indicated that may be the case. For example, a study published in the Journal of the American Medical Association in 2016 found that people who attended either a weekly meditation or CBT session for eight weeks showed significant functional improvement in back pain compared to those receiving standard care.
According to the National Library of Medicine, CBT often involves 10 to 20 meetings with a therapist and focuses on the types of thoughts and feelings that occur with back pain. Although you might not be able to stop pain from flaring, CBT may help you direct your mind in a way that reduces pain response.
When that happens, it can help you become or stay more active, which is hugely important for pain management, according to Neel Anand, M.D., professor of orthopedic surgery and director of spine trauma at Cedars-Sinai Spine Center in Los Angeles.
“Regular, low-impact exercise is incredibly beneficial for back pain,” he told Bicycling. “Not only does it help mobility overall, but it strengthens the muscles that surround the spine, creating greater support and alleviating tension in the low back.”
Addressing back pain with a tailored approach that includes mental as well as physical factors can be a boon for long-term relief, he added.
Elizabeth Millard is a freelance writer focusing on health, wellness, fitness, and food.
