Intensive patient education does not improve low back pain outcome
Adding 2 hours of patient education to recommended first-line care in patients with acute low back pain does not improve their pain outcomes, a recent study has shown.
In this randomized trial, 202 patients with acute low back pain received recommended first-line care, and were randomized to receive additional two 1-hour sessions of patient education (information on pain and biopsychosocial contributors plus self-management techniques, such as remaining active and pacing) or placebo education (active listening, without information or device). [JAMA Neurol 2018, doi: 10.1001/jamaneurol.2018.3376]
The primary outcome was pain intensity at 3 months (11-point numeric rating scale). Secondary outcomes included disability at 1 week, and at 3, 6 and 12 months (24-point Roland Morris Disability questionnaire).
Results showed that intensive patient education was not more effective than placebo education at reducing pain intensity (3-month mean pain intensity, 2.1 vs 2.4; mean difference, -3). There was a small benefit with intensive patient education on the secondary outcome at 1 week (mean difference, -1.6) and 3 months (mean difference, -1.7), but not at 6 or 12 months.
“These short-term effects were below published guidance on clinically meaningful effects [2 points on a 24-point Roland Morris Disability Questionnaire and 1 point on a 11-point numeric rating scale],” the study authors noted.
“Our results challenge a widespread belief that patient education is an effective strategy for treatment of acute low back pain. For example, every clinical guideline recommends patient education to manage acute low back pain. These recommendations are, however, often unaccompanied by an evidence statement or instruction on how patient education interventions should be conducted,” they continued.
“As shown in our study, 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,” the authors concluded. “Clinical guideline recommendations to provide complex and intensive support to high-risk patients may have been premature.”