84% More Successful – Scientists Reveal the Most Effective Treatment for Back Pain

Back Pain Spinal Cord

Nearly 65 million Americans say they’ve recently experienced back pain.

A Goethe University Frankfurt study found that a combined approach works best.

Back pain is a common condition with numerous causes, including poor posture, overexertion, constant stress at work or at home, lack of exercise, and poor posture. For a considerable number of patients, the symptoms are chronic, meaning they last a long period or reoccur repeatedly. However, port and exercise therapy, when done properly, can provide alleviation.

Physiotherapy, as well as strength and stability exercises, are common treatment options. But how can the treatment be as effective as possible?  Which method reduces pain the most effectively? A recent meta-analysis published in the Journal of Pain by Goethe University Frankfurt revealed new insights.

The researchers began with data from 58 randomized controlled trials (RCTs) involving over 10,000 individuals suffering from chronic low back pain throughout the globe. The relevant data from the original manuscripts were first filtered out and then analyzed in groups. When analyzing this data, the researchers looked at whether and how conventional forms of therapy and individualized treatment varied in terms of outcome. “Individualized” refers to some kind of personal coaching where therapists precisely target the needs and potentials of each patient and collaborate with them to choose the course of their treatment.

People who sit a lot and do not exercise often develop back pain. Credit: Markus Bernards for Goethe University Frankfurt

According to the research, individualized therapy for chronic back pain had a much greater impact than conventional exercise therapies. The success rate for pain alleviation was 38% more than with conventional therapy.

“The higher effort required for individual treatment is worthwhile because patients benefit to an extent that is clinically important,” says lead author Dr. Johannes Fleckenstein from the Institute of Sport Sciences at Goethe University Frankfurt.

However, the study went even further. The research team in Frankfurt compared a third group of treatment methods alongside the standard and individualized ones. In this group, individualized training sessions were combined with cognitive behavioral therapy (CBT). This procedure – a type of talk therapy – is based on the assumption that negative thoughts and behaviors surrounding pain tend to exacerbate it. Through CBT, pain patients learn to change the way they handle it.

They stop being afraid to move or are taught tactics for coping with pain. This makes them realize that they are by no means helpless. But what does psychotherapeutic support through CBT actually contribute to the success of the treatment? Analysis of the data revealed the following: When an individualized approach and CBT were combined, the success rate in terms of pain relief was an impressive 84 percent higher than with standard treatment. The combined therapy, also called multimodal therapy, thus led to the best result by far.

Fleckenstein sees in the study “an urgent appeal to public health policy” to promote combined therapies both in terms of patient care and remuneration. “Compared to other countries, such as the USA, we are in a relatively good position in Germany. For example, we issue fewer prescriptions for strong narcotic drugs such as opiates. But the number of unnecessary X-rays, which, by the way, can also contribute to pain chronicity, and inaccurate surgical indications are still very high.”

This is also due, according to Fleckenstein, to economic incentives, that is, the relatively high remuneration for such interventions. The situation is different for organizations working in the area of pain therapy, he says. Although these are not unprofitable, they are not a cash cow for investors either. In his view, it is important here to improve the economic conditions. After all, pain therapy saves a lot of money in the long run as far as health economics are concerned, whereas tablets and operations rarely lead to medium and long-term pain relief.

Reference: “Individualized Exercise in Chronic Non-Specific Low Back Pain: A Systematic Review with Meta-Analysis on the Effects of Exercise Alone or in Combination with Psychological Interventions on Pain and Disability” by Johannes Fleckenstein, Philipp Floessel, Tilman Engel, Laura Krempel, Josefine Stoll, Martin Behrens and Daniel Niederer, 29 July 2022, Journal of Pain.
DOI: 10.1016/j.jpain.2022.07.005


View Comments

  • "X-Rays contribute to pain chronicity?" Whoa! That was researched? This fellow calls for CBT sessions for sufferers of back pain? Over 60% of Americans on the couch for back pain? I doubt tis will happen since most of America's nutcakes can't get therapy and insurance coverage in the US is not even good enough to be "spotty." Mental health professionals at Kaiser-Permanente just went on strike because of understaffing. Lastly, these folks have never heard of Chiropractic therapy? This is a gigantic out (of course they could be members of the AMA.)

  • ChiroQuackers are not real doctors and are taught, believe, and practice some of the most outrageous and damaging things.

  • You obviously know nothing about Chiropractors! Chiropractors are doctors. They graduate as Doctors of Chiropractic. They go through most of the training Medical Doctors go through in fact in some states they can be your primary doctor. I have Degenerative Disc Disease and using a Chiropractor helps so much with my chronic pain.

  • This article is Nothing new ! I have a long history of damage. The only thing that has helped me is surgery! Talk therapy may help some!, but most of us are way past there.

  • Chiropractors and physical therapists go through much more training than you think. Now of course there is a difference on going to a $10 chiropractor at a flea market and going to a professional.

  • As someone who lives in chronic pain everyday, from 4 failed back surgeries, I can honestly say CBT does not help most people with chronic back pain. The very definition of chronic means long lasting and talking about your pain does not make the pain go away. I have done CBT with indiv. Physical therapy and someone telling me not to be scared of the pain just makes it worse. Imagine waking up everyday and knowing your pain will be there usually at least an 8 out of 10. What makes it worse is taking people's pain medicine away because then they can not fight it. The very best thing for back pain is movement and without medication movement isn't possible.

Goethe University Frankfurt

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