Australia study validates Indian doctors’ use of brain retraining to cure chronic back pain

The conventional treatment for chronic back pain includes medication, spinal manipulative therapy, spinal injections, surgery or spinal cord stimulation methods.

But researchers now look at chronic back pain as a problem of the nervous system rather than the spinal disc, bone or muscle tissue.

CBT for long-term cure

CBT Practitioner Dr Ashritha M told South First, “CBT- based sensorimotor retraining interventions have worked for pain and stroke patients too.

Cognitive Behavioural Therapy method to treat chronic back pain (Creative Commons)

She says the nervous system of people suffering from pain, especially chronic pain, behaves differently than people who have had injury-related pain.

“Normally, after diagnosis, the patients are told that the back now is vulnerable and needs to be protected. This suggestion changes how a person filters and interprets information from the back and how we move it,” she said.

“So, over time, the back becomes less fit and stiffens up as the brain, and back communication is disrupted because the notion that the back is vulnerable is reinforced,” Dr Ashritha added.

Dr Praveen Reddy, an orthopaedic surgeon, says, “The program may help some people who believe in this therapy and for those who are not looking for a quick fix with pain killers,”

Orthopaedic doctors say that trained physiotherapists, physiologists who work in specific body-related exercises, and clinicians who understand how to recognise chronic pain can be trained to perform such therapies.

What does the study say?

The study published in the Journal of the American Medical Association did a randomised clinical trial in which 276 participants underwent graded sensorimotor retraining intervention.

It is a technique aimed at restoring motor controls through a gradual increase in sensory inputs to the brain.

The researchers found a significant improvement in pain intensity at the end of 18 weeks.

Backpain/Creative Commons

Professor James McAuley from UNSW’s School of Health Sciences said, “Sensorimotor retraining alters how people think about their body in pain, how they process sensory information from their back and how they move their back during activities.”

“People were happier, reported that their backs felt better, and their quality of life improved,” the study revealed.

“It also looks like these effects were sustained over the long term; twice as many people were completely recovered,” it said.

Very few treatments for low back pain show long-term benefits, but participants in the trial reported improved quality of life one year later,” it said.

Sensorimotor Retraining Therapy

Dr Umesh Srikantha, Consultant Neurosurgeon , explained that messages travel in the form of electrical impulses between the brain and other body parts through special cells called neurons.

The researchers in the study explain that they have tried to achieve three goals.

First, to align the patient’s understanding of what leads to chronic back pain with the scientific reasons for causes of back pain.

Second, they have tried to normalise the way back, and the brain communicates with each other, wherein, instead of negative perceptions through therapy, they have sent positive perceptions of relief.

The third is gradually training the mind and body to resume daily activities.

Professor Ben Wand of Notre Dame University, the clinical director of the trial, said that this sensorimotor training program helps patients understand that their brains and backs are not communicating well.

They can also experience improvement in communication, he said.

During the sensorimotor retraining therapy, along with the fitness of the back, what the patient thinks about their back, their back pain, how the brain and back communicate, and even how the back is moved are considered.

However, the authors want to do more research to replicate the results in different populations and try the same approach with other such pains.

Indian doctors’ take

Orthopaedic surgeon from Bengaluru Srikanth R told South First,” I have seen patients with chronic back pain feel their pain usually when they are in resting position like sitting and sleeping etc. This is because they are otherwise occupied with their work and have paid little attention to the pain,”

Psychiatrist from Bengaluru, Dr Vijaykumar S, thinks that the basis of the study is based on the fact that pain is a gating mechanism.

He said that pain is normally ignored when you are engaged in some work.

“The brain has the potential to block pain signals and is sensitive to pain signals. The more you pay attention to a body part, the more signals it will send to the brain,” he said.

“When you focus your attention elsewhere, you learn to relax those body parts,” he added.

However, Dr Srikanth says that the time period and the number of people subjected to the study is too less and will need further studies.

He says that people with chronic back pain suffer for many years.

“This is a first-of-its-kind study. However, if the same results are replicated in a larger population, then it will definitely be beneficial,” he added.