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University of Limerick study shows personalised treatments can have significant impact on back pain

Dr Kieran O'Sullivan, University of Limerick, principal investigator on the study
Wed, 23 Oct 2019

A new study by researchers at University of Limerick has found that a “personalised approach” to back pain treatment can have a significant impact.

Back pain is the most costly and disabling health condition in the world, with the costs of back pain exceeding that of cancer and diabetes combined. For decades, most treatments for back pain have had little or no impact on the condition.

However, the UL study, which has just been published in the British Journal of Sports Medicine, has shown that there may be cause for more optimism.

In the study – a randomised controlled trial of over 200 people conducted in Co Mayo and coordinated by UL – people who received personalised treatment, which specifically matched their health needs, did better than those who received similar recommended care in a non-personalised manner.

Even though the personalised treatment - cognitive functional therapy - only involved an average of five treatments, those who received it were significantly less disabled when followed up after one year. These findings are consistent with another clinical trial using the same personalised approach for back pain in Norway.

The study was funded by the Irish Research Council and conducted in conjunction with the HSE and with international collaborators at Curtin University, Perth, Australia. It was the first clinical trial of personalised care for low back pain carried out within the HSE.

Speaking about the trial, principal investigator Dr Kieran O’Sullivan from UL, explained: “Right now, nobody can say any particular treatment will cure back pain.

“However, this trial - in line with some other recent trials internationally - highlights two important aspects; first, that back pain treatment likely requires us to address both physical and non-physical factors, even though most treatment currently overwhelmingly focuses only on the physical factors; and secondly, that there might be value in better tailoring treatments according to the needs of patients, so that they get the treatment they need, rather than what any particular clinician feels comfortable doing,” he added.

Dr O’Sullivan, a senior lecturer in physiotherapy at UL’s School of Allied Health, explained that it has been clear for decades that back pain is influenced by not only physical factors, such as strength, posture and flexibility, but also psychological factors such as worries and mood, and lifestyle factors such as sleep and fitness.

In this trial, patients with back pain received personalised treatment according to their own needs – in some cases the emphasis was on physical factors such as strength and fitness, whereas in other cases the emphasis was more on non-physical factors such as stress levels, or sleep. In all cases, the fact that back pain can be linked to both physical and non-physical factors was explained to people, he outlined.

This personalised approach to back pain is now being examined in another trial in Australia in which Dr O’Sullivan is involved. He highlighted some issues for consideration if such an approach was to be used more widely.

“First, we need to repeat these trials, especially to examine the economic consequences of reducing disability in terms of sick leave and so on,” he explained.

“Thereafter, we likely need to fundamentally alter how we train clinicians who treat people with pain, and how services are offered to people with pain. Unfortunately right now, it is often easier for people with back pain to get access to ineffective treatments, even when they are more expensive than good treatments,” he added.

The study - Cognitive functional therapy compared with a group-based exercise and education intervention for chronic low back pain: a multicentre randomised controlled trial (RCT) by Mary O'Keeffe, Peter O'Sullivan, Helen Purtill, Norma Bargary and Kieran O'Sullivan – has just been published in the British Journal of Sports Medicine.

Link to the study here: https://bjsm.bmj.com/content/early/2019/10/18/bjsports-2019-100780.