Behavioural therapy and exercise rehabilitation may be as effective as surgery in treating patients with Chronic Low Back Pain (CLBP), a study published in the Journal 'Spine' last week suggests (see: Long-Term Follow-up Suggests Spinal Fusion Is Associated With Increased Adjacent Segment Disc Degeneration But Without Influence on Clinical Outcome: Results of a Combined Follow-up From 4 Randomized Controlled Trials).
In the UK, about 26 million people suffer from lower back pain each year and four million can expect to suffer from chronic lower back pain at some point in their lives. The condition was identified as the most common cause of disability in young adults: with more than 100 million workdays lost per year in the UK alone. Worldwide, low back pain remains a leading cause of disability and is responsible for around 13% of all reported annual sickness absence days.
The Spine study, led by Professor Jeremy Fairbank of NDORMS and a consultant orthopaedic surgeon specialising in spinal disorders, looked at the combined follow-up from four clinical trials and compared the long-term outcome of patients who had either spinal fusion surgery or multidisciplinary behavioural therapy and exercise rehabilitation for CLBP. After an average of 11 years' follow-up, it has been shown there is no important difference in patient self-rated outcomes between those who have had surgery and those who had behavioural therapy and exercise rehabilitation.
Furthermore, the study supports the ongoing discussion that fusion of the spine is associated with a faster degeneration of the neighbouring segment of the spine, in the long term after surgery; however, this degeneration does not have an impact on pain.
Professor Jeremy Fairbank said:
"The results suggest that in health care systems where behavioural therapy and exercise rehabilitation programmes are available this should be the preferred option for CLPB patients, as it is as effective as spinal fusion surgery in managing pain and does not increase degeneration of the spine over time."
"The UK has, for some time, had a low rate of spinal fusion procedures compared with other countries, but few countries has a high availability of CBT based intensive rehabilitation studies. The original UK-MRC study convinced NICE to recommend this treatment, although in few countries (including the UK) is it widely available. The Physiotherapy department at the NOC should take credit for their work over many years to make these packages of treatment effective and widely available."
"Nationally and internationally there are two main challenges: first to discourage surgeons and patients and implant manufacturers to press for ineffective surgical treatment, and second to set up well organized and properly reimbursed systems that can deliver CBT and intensive exercise therapy."
"Oxford, and specifically the physiotherapy department at the NOC has much to claim credit for developing this research work which if implemented has a major impact on the management of chronic back pain."
The study won the 2014 International Society for the Study of the Lumbar Spine (ISSLS) Prize for Lumbar Spine Research, because the findings settle a long standing debate amongst spine surgeons and will influence the advice given to patients in the future.