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Low back pain is a leading cause of disability worldwide with many treatments, such as medication, often failing to provide lasting relief. Researchers from the University of Sydney's Center for Rural Health have uncovered a possible solution. Their study, published in JAMA Network Open, found integrating lifestyle support into back pain care could reduce disability and enhance quality of life.
The randomized controlled trial involved 346 participants from various regions in Australia, each suffering from chronic low back pain and possessing at least one lifestyle risk factor, including obesity, an unhealthy diet, lack of physical activity, or smoking. The participants were randomly divided into two groups: one received the "Healthy Lifestyle Program (HeLP)", while the other group was given standard guideline-based physiotherapy treatment for their low back pain.
Participants in the HeLP program were assisted by physiotherapists, dietitians, and telephone health coaches who guided them in identifying lifestyle factors that could be contributing to their back pain. These factors included weight issues, lack of physical activity, unhealthy eating habits, inadequate sleep, smoking, and high alcohol consumption. Over the course of six months, they received research-backed recommendations aimed at tackling these lifestyle challenges.
The method demonstrated multiple advantages over conventional treatment, such as decreased levels of disability, with participants achieving an average score that was 1.3 points lower on the Roland Morris Disability Questionnaire (where higher scores reflect increased disability). Additionally, those in the HeLP group experienced an average weight loss of 1.6 kg more than those in the control group.
Chief Investigator Associate Professor Chris Williams noted that the results confront conventional perspectives on managing back pain. "Addressing back pain requires a broader approach that goes beyond just the back. Our bodies function more like ecosystems, with numerous interacting factors influencing our overall well-being. Back pain is simply another example of this complexity."
"When individuals experience persistent back pain, it's crucial for them to anticipate receiving thorough care that addresses various health aspects, rather than solely concentrating on spinal issues. This message needs to be broadcasted far and wide."
"Numerous recent studies indicate that conditions such as bulging discs and joint degeneration are seldom the root cause of chronic back pain," stated Associate Professor Williams. "Unfortunately, many individuals are not informed of this fact, and even fewer receive guidance to address the factors that contribute to prolonged pain and disability. A significant number of people end up being directed towards surgery or prescribed medications that are ineffective—and may potentially cause further issues."
The research highlights the importance of transforming back pain management by moving away from reliance on medications and surgical interventions, and instead focusing on the lifestyle elements that can significantly impact recovery.
Dr. Emma Mudd, Senior Research Officer at the University of Sydney and lead author, highlighted the potential real-world benefits of the program. "Numerous individuals suffering from chronic back pain express feelings of neglect, frequently being directed towards expensive and ineffective therapies without being presented with suggested treatments that encourage self-management," Dr. Mudd remarked.
"By emphasizing lifestyle modifications and offering straightforward, supportive measures, patients gain the confidence to manage their pain effectively. This strategy not only alleviates their symptoms but also significantly boosts their overall quality of life."
The researchers are of the opinion that lifestyle-integrated care, similar to the HeLP program, could offer advantages to patients that extend beyond just pain relief, possibly lowering the risk of other chronic illnesses. Nevertheless, Dr. Mudd pointed out that international guidelines have not yet completely adopted this strategy:
"Our study may impact future revisions of back pain protocols. Patients appreciated the comprehensive support, and the results are telling."
"According to Associate Professor Williams, healthcare providers managing back pain should take into account the incorporation of lifestyle support into their regular treatment routines. There isn't necessarily a definitive method for this approach; what matters most is that patients feel acknowledged and involved in the decision-making process."
More information: Emma Mudd et al, Healthy Lifestyle Care vs Guideline-Based Care for Low Back Pain, JAMA Network Open (2025). DOI: 10.1001/jamanetworkopen.2024.53807
Supplied by the University of Sydney
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