Pain Education May Not Improve Acute Low Back Pain

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During patient education sessions, pain, biopsychosocial pain contributors, and self-management strategies were discussed.
During patient education sessions, pain, biopsychosocial pain contributors, and self-management strategies were discussed.

The addition of a 2-hour patient education session to first-line care may not benefit patients with acute low back pain, according to a study published in JAMA Neurology.

A total of 202 patients with acute low back pain for <6 weeks were recruited from general practice, physiotherapy clinics, and a research center in Australia. In addition to first-line care, study participants were randomly assigned to receive two 1-hour educational sessions (n=101) or placebo patient education sessions (n=101). During patient education sessions, pain, biopsychosocial pain contributors, and self-management strategies (eg, physical and pacing activities) were discussed. Placebo education sessions consisted of active listening without additional information or advice. 

Pain intensity at 3 months (evaluated with an 11-point numeric rating scale) was the study's primary outcome. Additional outcome measures were disability at 1 week and at 3, 6, and 12 months, assessed using the 24-point Roland Morris Disability Questionnaire.

At all points, retention rates were >90% in both groups. The addition of patient education vs placebo to first-line care was not associated with greater efficacy in reducing pain intensity at the 3-month follow-up (mean difference, −0.3 point [2.1 vs 2.4, respectively]; 95% CI, −1.0 to 0.3; P =.31). Patient education improved disability at 1 week (mean difference, −1.6 points; 95% CI, −3.1 to −0.1 points) and 3 months (mean difference, −1.7 points; 95% CI, −3.2 to −0.2 points).

"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," concluded the study authors.

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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: A randomized clinical trial [published online November 5, 2018]. JAMA Neurol. doi: 10.1001/jamaneurol.2018.3376

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