From: Goethe University
October 18, 2022 -- If a therapy for chronic back pain is
tailored specifically to a patient’s individual requirements, the chances of
success are far greater than with standard forms of treatment. Accompanied by a
psychotherapeutic procedure in the shape of cognitive behavioural therapy, the
pain can be alleviated even more effectively. This is the result of a
meta-analysis by Goethe University Frankfurt, in which the data of over 10,000
patients were combined and analysed. It can be concluded from the study that
multimodal therapies should be promoted on a larger scale in the German
healthcare system, in line with the National Disease Management Guidelines.
Lack of exercise, bad
posture, overexertion, constant stress at work or at home – back pain is a
widespread condition with many causes. For a not insignificant number of
sufferers, the symptoms are even chronic, meaning they persist for a long time
or recur again and again. Sport and exercise therapies under instruction can
bring relief. Common treatment methods include physiotherapy as well as
strength and stability exercises. But how can the therapy be as successful as
possible? Which approach alleviates pain most effectively? A meta-analysis by
Goethe University Frankfurt, published recently in the Journal of Pain, has
delivered new insights.
The starting point was
data from 58 randomised controlled trials (RCTs) of over 10,000 patients
worldwide with chronic low back pain. First, the data relevant to the topic
were filtered out of the original manuscripts and then evaluated in groups.
When evaluating these data, the researchers examined on the one hand whether
and to what extent standard forms of treatment and individualised treatment
differ in terms of the result. “Individualised” means that there is some type
of personal coaching, where therapists specifically target the potentials and
requirements of each patient and decide together with them how their therapy
should look.
The study concluded
that individualised treatment for chronic back pain led to a significantly
increased effect in comparison to standard exercise therapies. The success rate
in pain relief was 38 percent higher than with standard treatment. “The higher
effort required for individual treatment is worthwhile because patients benefit
to an extent that is clinically important,” says lead author Dr Johannes
Fleckenstein from the Institute of Sport Sciences at Goethe University
Frankfurt.
However, the study went
even further. The research team in Frankfurt compared a third group of
treatment methods alongside the standard and individualised ones. In this
group, individualised training sessions were combined with cognitive
behavioural therapy (CBT). This procedure – a type of talk therapy – is based
on the assumption that negative thoughts and behaviours surrounding pain tend
to exacerbate it. Through CBT, pain patients learn to change the way they
handle it. They stop being afraid to move or are taught tactics for coping with
pain. This makes them realise that they are by no means helpless. But what does
the psychotherapeutic support through CBT actually contribute to the success of
the treatment? Analysis of the data revealed the following: When an
individualised approach and CBT were combined, the success rate in terms of
pain relief was an impressive 84 percent higher than with standard treatment.
The combined therapy, also called multimodal therapy, thus led to the best
result by far.
Fleckenstein sees in
the study “an urgent appeal to public health policy” to promote combined
therapies both in terms of patient care and remuneration. “Compared to other
countries, such as the USA, we are in a relatively good position in Germany.
For example, we issue less prescriptions for strong narcotic drugs such as
opiates. But the number of unnecessary X-rays, which, by the way, can also
contribute to pain chronicity, and inaccurate surgical indications is still
very high.” This is also due, according to Fleckenstein, to economic
incentives, that is, the relatively high remuneration for such interventions.
The situation is different for organisations working in the area of pain
therapy, he says. Although these are not unprofitable, they are not a cash cow
for investors either. In his view, it is important here to improve the economic
conditions. After all, pain therapy saves a lot of money in the long run as far
as health economics are concerned, whereas tablets and operations rarely lead
to medium and long-term pain relief.
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