Comparison of physical treatments versus a brief pain management programme for back pain in primary care: A randomised clinical trial in physiotherapy practice

Primary Care Sciences Research Centre, Keele University, Staffordshire, UK.
The Lancet (Impact Factor: 45.22). 06/2005; 365(9476). DOI: 10.1016/S0140-6736(05)66696-2
Source: OAI


Recommendations for the management of low back pain in primary care emphasise the importance of recognising and addressing psychosocial factors at an early stage. We compared the effectiveness of a brief pain-management programme with physiotherapy incorporating manual therapy for the reduction of disability at 12 months in patients consulting primary care with subacute low back pain.
For this pragmatic, multicentre, randomised clinical trial, eligible participants consulted primary care with non-specific low back pain of less than 12 weeks' duration. They were randomly assigned either a programme of pain management (n=201) or manual therapy (n=201). The primary outcome was change in the score on the Roland and Morris disability questionnaire at 12 months. Analysis was by intention to treat.
Of 544 patients assessed for eligibility, 402 were recruited (mean age 40.6 years) and 329 (82%) reached 12-month follow-up. Mean disability scores were 13.8 (SD 4.8) for the pain-management group and 13.3 (4.9) for the manual-therapy group. The mean decreases in disability scores were 8.8 (6.4) and 8.8 (6.1) at 12 months (difference 0 [95% CI -1.3 to 1.4], p=0.99), and median numbers of physiotherapy visits per patient were three (IQR one to five) and four (two to five), respectively (p=0.001). One adverse reaction (an exacerbation of pain after the initial assessment) was recorded.
Brief pain management techniques delivered by appropriately trained clinicians offer an alternative to physiotherapy incorporating manual therapy and could provide a more efficient first-line approach for management of non-specific subacute low back pain in primary care.

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    • "CLBP may affect both functioning and quality of life mediated by decrease in physical, emotional and social factors. Physiotherapists have accordingly shifted towards a biopsychosocial approach and there is evidence that a biomedical approach is insufficiently effective (Hay et al. 2005). There are multiple biopsychosocial treatment options which are currently evidence based including cognitive therapy combined with exercise therapy, operant approaches or contextual treatment such as mindfulness or acceptance and commitment therapy (ACT) (Keefe et al. 2004). "
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