1. This randomized clinical trial demonstrated that among 276 adult patients with moderate to severe chronic lower back pain, graded sensorimotor retraining significantly improved pain intensity at 18 weeks compared to sham procedures.

2. Given that this trial was conducted at a single centre and after 1 year post-treatment, mean pain intensity improvement was not significantly different between treatment and placebo groups, further research into graded sensorimotor retraining is required to better understand the efficacy of this treatment intervention.

Evidence Rating Level: 1 (Excellent)

Study Rundown: The neural processing mechanisms contributing to chronic pain are not well understood. In particular, chronic low back pain is widely prevalent with limited effective treatment options. Graded sensorimotor retraining is a new treatment that attempts to alter the sensory processing of pain. This randomized clinical trial examined the efficacy of this new intervention for patients living with moderate to severe chronic low back pain. Patients were recruited by primary care providers at a medical research institute in Sydney, Australia, between November 1, 2015, and July 28, 2019. Adults between ages 18 and 70 years were included if they reported low back pain with an intensity rating of at least 3/10 on an 11-point numerical rating scale that persisted for at least 3 consecutive months; those with low back pain due to a serious medical condition or from previous surgery were excluded. Participants were randomly assigned to receive graded sensorimotor retraining intervention (n= 138) or attention control with a sham procedure (n= 138). The primary outcome was mean pain intensity from the previous week assessed using an 11-point numerical rating scale at 18 weeks post-randomization. Mean pain intensity improved from 5.6 to 3.1 in the intervention cohort compared to 5.8 to 4.0 in the control group at 18-weeks (estimated mean difference [EMD]: -1.0 [95% CI: -1.5 to -0.4]; p= 0.001). However, after 52 weeks, there was no significant difference in the estimated mean difference between groups (EMD: -0.5 [95% CI: -1.1 to 0.1]; p= 0.09). Furthermore, the intervention group demonstrated significantly improved quality of life based on the EQ-5D-5L questionnaire (EMD: 0.1 points [95% CI: 0.0-0.1]; p= 0.02) and reduced disability (EMD: -2.6 points [95% CI: -3.9 to -1.3]; p< 0.001) at 18 weeks. Conversely, depression (EMD -0.8 points [95% CI: -2.0 to 0.3]; p= 0.16) and insomnia (EMD: -1.8 [95% CI: -3.7 to 0.1]; p= 0.06) were not significantly reduced in the intervention cohort compared to control after 18 weeks post-randomization. There were no serious adverse events reported in either group. Overall, this clinical trial demonstrated that grade sensorimotor retraining significantly improved pain intensity after 18 weeks compared to sham procedure in adult patients with moderate to severe chronic lower back pain. One limitation of this study, however, is that treating clinicians and physiotherapists were not blinded to randomization since they were the providers for both treatment groups. Additionally, this study was single-centred, which necessitates the need for further research at various other sites to support these results.

Click to read the study in JAMA

Relevant Reading: The prognosis of acute and persistent low-back pain: a meta-analysis

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