Intensive Education Does Not Improve Low Back Pain Outcomes, Study Reports

The Global Burden of Disease Study has ranked low back pain as a leading cause of disability worldwide, and the Lancet Low Back Pain Series Working Group has recommended that researchers and policy makers develop and implement strategies to identify and educate patients with low back pain who are at risk of persistence of pain and disability.

While pain education has shown utility in treating some groups of patients with chronic pain, little is known about the effect of pain education in patients with low back pain. A new study, published in JAMA Neurology, sought to address this gap in the literature through the PREVENT study—a randomized, placebo-controlled trial of patient education for low back pain.

The trial, conducted in Sydney, Australia, recruited 202 patients aged 18 to 75 years who were receiving care for low back pain, and randomized them 1:1 to receive either intensive education or placebo education.

Intensive education used information and advice gleaned from a text called Explain Pain, and included such activities as “reframing unhelpful beliefs about low back pain,” presenting information about the biology of back pain, and discussing techniques to promote recovery. Patients in the placebo group received no information, advice, or education, though they were encouraged to talk to their clinician about any topics that concerned them.

Patient-reported data were collected at baseline and at 3, 6, and 12 months after the onset of pain. The primary outcome was mean pain intensity during the past week, reported on an 11-point intensity scale, assessed 3 months after pain onset.

The researchers found that intensive patient education was no more effective than the placebo at reducing pain intensity at 3 months after onset (3-month follow-up mean difference, —0.3 points on an 11-point scale; 95% CI, –1.0-0.3; P=.31). Mean (SD) pain intensity decreased from 6.3 (2.4) at baseline to 2.1 (2.4) at 3 months in the intensive education group and from 6.1 (2.2) at baseline to 2.4 (2.2) at 3 months in the placebo group. A small impact on disability was observed at week 1 and month 3, but no differences were found between the groups at 6 or 12 months.

Some differences emerged between groups in secondary outcomes: the odds of having a recurrence of low back pain at 12 months were lower for the education group (odds ratio [OR], 0.44; 95% CI, 0.24-0.82). Both pain interference (mean difference, —0.8; 95% CI, –1.5 to –0.1; P =.02) and the odds seeking further healthcare (OR, 0.43; 95% CI, 0.19-0.93) were lower in the education group at 3 months, but not at 6 or 12 months.

Education was not more effective than placebo for reducing depressive symptoms, incidence of chronic low back pain, or global perceived change.

“For patients with acute low back pain who received first-line care, intensive patient education was no more effective than a placebo intervention,” concluded the authors. “Adding complex, time-consuming treatments to primary care—based advice and reassurance is likely to be unnecessary for most patients with acute low back pain.”

Reference

Traeger AC, Lee H, Hübscher M, et al. Effect of intensive patient education vs placebo patient education on outcomes in patients with acute low back pain [published online November 5, 2018]. JAMA Neurol. doi: doi:10.1001/jamaneurol.2018.3376.