Exercise, Return to Activity Helps Back Pain
Patients in Study Fared as Well With Behavioral Treatment or Physical Therapy
June 9, 2005 -- Low back pain is one of the most common and difficult-to-treat medical complaints among adults. Treatment often includes physical therapy, but new research shows that a hands-off educational and behavioral approach to pain management works just as well.
Researchers say people in the study who suffered from short-duration low back pain responded well to counseling programs that explored their attitudes toward pain and urged them to exercise and resume routine activities despite their discomfort.
"This approach targets erroneous beliefs about back pain, like the belief that exercise is bad because it hurts," study researcher Krysia Dziedzic, PhD, of Keele University in Staffordshire, England, tells WebMD. "It encourages people to stay active and teaches them how to better manage pain when they have it."
Dziedzic, researcher Elaine Hay, and colleagues followed 400 patients with low back pain of unknown origin for a year.
Half of the patients were treated with a standard course of physical therapy that included spinal manipulation. This included up to seven 20-minute treatment sessions. The other half got the two-day educational and behavioral therapy course, which was supplemented by tutoring with the use of a treatment log.
None of the patients had had back pain for more than three months, and both types of therapy were delivered by physical therapists.
The researchers reported that clinical outcomes were the same at three months and 12 months for patients in both treatment groups. A total of 68% of patients in the behavioral group reported that they were much better or completely better one year later, compared with 69% of patients in the manual physical therapy group.
The study is published in the June 11 issue of The Lancet.
The findings show that manual therapy is not essential as an initial treatment for patients with low back pain of only a few weeks' or months' duration, Hay says.
"The pain-management package was delivered in fewer treatment sessions, resulted in fewer referrals to secondary care than the traditional approach, and might be an efficient first-line approach to care for patients with low back pain."