Low back pain: education ineffective at 3-month mark

  • JAMA Neurol

  • curated by Jenny Blair, MD
  • Clinical Essentials
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Takeaway

  • For patients with low back pain (LBP) at risk of developing chronic LBP, addition of intensive patient education does not improve pain scores.
  • Authors: guideline recommendations advising intensive patient education may have been premature.

Why this matters

  • LBP is the world's leading cause of disability.
  • Most care is guideline-discordant, and first-line treatment often fails.
  • All major guidelines recommend patient education, but this has not been trialled.

Key results

  • At 3 months, between-group difference in pain score change: −0.3 points (11-point scale; 95% CI, −1.0 to 0.3; P=.31).
  • Education vs placebo groups:
    • Recurrence within 12 months: OR, 0.44 (95% CI, 0.24-0.82);
    • Pain attitudes: mean difference, –0.9 (95% CI, –1.2 to –0.5; P<.001>

Study design

  • Randomized, multicenter, placebo-controlled, clinical Preventing Chronic Low Back Pain (PREVENT) Trial in Sydney, Australia.
  • 202 participants were outpatients with LBP
  • In addition to usual first-line care, they were randomly assigned to 2-hour sessions of patient education by physiotherapists vs active listening.
  • Outcome: pain intensity at 3 months after pain onset.
  • Funding: Australian National Health and Medical Research Council.

Limitations

  • Outcome might have differed with more sessions or if sessions had been delivered by primary providers.

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