When conducted by physiotherapists, a pain management program that includes exercise advice and strategies to overcome psychosocial barriers is a suitable alternative to physical therapy for low back pain, according to a report in the June 11th issue of The Lancet.

“The pain management package was delivered in fewer treatment sessions, resulted in fewer referrals to secondary care than the traditional approach, and might be an efficient first-line approach to care of patients with low back pain in primary-care practice,” lead author Dr. E. M. Hay, from Keele University in Staffordshire, UK, said in a statement.

The findings are based on a study of 402 patients with low back pain of less than 12 weeks’ duration who were randomly assigned to participate in the pain management program or physical therapy. Of these subjects, 329 were available for 12-month follow-up.

The two approaches provided a pronounced and identical improvement in the subjects’ average disability scores at follow-up, the investigators report. However, the average number of therapy visits per patient was three in the pain management group compared with four in the traditional physical therapy group.

In a related editorial, Dr. Paul G. Shekelle, from the Greater Los Angeles VA Healthcare System, and Dr. Anthony M. Delitto, from the University of Pittsburgh, comment that the study findings are probably applicable to the UK National Health Service and healthcare in other countries, but “there are important limitations.”

“Applying a ‘one-size-fits-all’ approach, and applying the brief pain-management programs or the (physical) therapy treatment to everyone…might have obscured the potential effectiveness of treatment targeted more specifically to patients for whom it is more likely to benefit.”

SOURCE: The Lancet, June 11, 2005.