Summary: Researchers say the old way of treating low back pain must change. It focuses too much on fixing something in the back. It ignores how the brain and spine talk to each other. In a new study, researchers showed that pain dropped when people with CLBP changed how they think about it. Chronic low back pain (CLBP) is the top cause of chronic pain and disability worldwide. Medicine has come a long way, yet it is still a big problem. The usual plan for CLBP is anti-inflammatory drugs, painkillers like opioids, and even invasive repair of worn-out disks. Doctors may also use spinal manipulation. Still, it appears some patients do not respond well to these treatments. Even surgery fails to bring relief in many cases. That is why these methods are under fire. So in recent years, researchers have started to look at CLBP in a new way. Like any other chronic pain, they think low back pain is more complex. The pain does not come only from changes in the spinal cord. For example, fMRI studies confirm that the brains of people with CLBP work differently. So we cannot ignore the brain’s role in this kind of pain. Put simply, CLBP comes from changes in both the spine and the brain. And the modern approach only makes things worse. People with CLBP live with fear. They are afraid to move their spine fully because they think it will hurt more. Medical advice feeds many of these fears. Patients with CLBP are often told to be careful with their spine. They are told to learn new ways to move that take stress off the spine. Now researchers think this advice may be making things worse. It may even help turn the pain chronic. One thing is missing from all these treatments. They miss that the brain plays a key role in how we feel pain. This is most true for long-lasting conditions like CLBP. The new study published in the journal JAMA confirms that focusing on the brain may help manage CLBP well. The new study was done on 276 patients randomly split into two groups. The first group, the intervention group, got graded sensorimotor retraining (RESOLVE). It mostly taught patients about low back pain and how to live with it. It also helped them get back to physical activity. The second group, the control group, got a sham treatment such as diathermy or laser. Both groups felt better by the end of the 18-week trial. But the gain was more significant in the intervention group. This study showed how much patient education and brain retraining matter for people with this condition. The researchers say these findings stand out in many ways. The treatment did not try to fix anything in the spine. It focused on retraining the brain. The findings suggest the brains of people with CLBP become more sensitive to pain. The researchers say larger studies are needed to fine-tune this approach for low back pain care. They also say that to help people with CLBP, we need to change how the brain and spine talk to each other.
Frequently asked questions
What is the new treatment for chronic low back pain?
The treatment is graded sensorimotor retraining, called RESOLVE. It does not try to fix something in the spine. It retrains how the brain and spine talk to each other. Patients learn about low back pain and how to live with it. Then they get help getting back to physical activity. In a JAMA trial of 276 patients, it beat sham treatment over 18 weeks.
What’s the worst thing you can do for back pain?
These researchers say one of the worst things is guarding your spine out of fear. Many people with chronic low back pain avoid moving fully because they expect it to hurt more. Medical advice to protect the spine often feeds that fear. Researchers now think this caution can make the pain worse and help turn it chronic.
Why doesn’t surgery always fix chronic low back pain?
Chronic low back pain is not only a spine problem. Brain imaging (fMRI) shows that the brains of people with chronic low back pain work differently. So the pain comes from changes in both the spine and the brain. Some treatments aim only at the back. Think anti-inflammatory drugs, opioids, manipulation or surgery on degenerated disks. They leave the brain side untouched.
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Dr. Gurpreet Singh Padda, MD, MBA, MHP
