A few years ago, I recall seeing many of my friends and acquaintances in physical therapy talk about how great “Explain Pain Supercharged” was in helping them and their patients understand how pain works. Although I have not yet read the whole book, I had read a few passages when I visited Dr. Sandy Hilton and Dr. Sarah Haag at their Chicago “Mecca” in November 2017. I loved the way Dr. Lorimer Moseley and Dr. David Butler describe and illustrate the concept of pain and its research, written in a way that most fifth graders would understand.
I thought this book was the Holy Grail to help my clients with chronic pain get even better. Pain eduction: That’s the Holy Grail.
However, a recent study published in JAMA Neurology challenged the idea that pain education is better than having no pain education. While much of the research in pain education in the past 20 years have shown benefits to people with low back pain of various intensities, pain education “ has never been tested in a placebo-controlled trial,” the study’s authors wrote. “Any benefits observed in previous trials of patient education for acute low back pain could be explained by nonspecific effects of the clinical encounter or the characteristics of the usual care comparison.”
That caught my attention. I brewed another pot of coffee and continued.
In the study, the researchers—led by Dr. Adrian Traeger from the University of Sydney in Australia—recruited 202 acute low back pain patients with or without referred leg pain from physician and physiotherapist referrals.
After they were randomly assigned to a pain education group or a placebo group. Traeger and his colleagues collected data after the first session, a second session a week later, and follow-ups in three, six, and 12 months.
In the placebo group, the sessions mimicked all aspects of patient education sessions, such as listening and showing interest, except they don’t have a pain education component.
Results?
In the primary outcome, the researchers found that pain education was not that much effective than the placebo group at reducing pain intensity during the three-month follow-up.
Pain Education Group Placebo Group
Baseline: 6.3 Baseline: 6.1
3 months: 2.1 3 months: 2.4
In the secondary outcomes, the researchers noted, “The odds of having a recurrence of low back pain at 12 months were lower in the patient education group than in the placebo patient education group. Pain interference and the odds of seeking health care were also lower in the patient education group at 3 months, but results for these variables were not lower at 6 or 12 months. Pain attitudes and reassurance at 1 week were higher in the patient education group.”
At first, this seems like the pain education group fared better than the placebo group. However, Traeger told Massage & Fitness Magazine that focusing on the primary outcome is the best way to interpret a trial.
“The secondary effects are interesting, but we can be much more certain about the effects on our primary outcome which was pain,” he said. “As you know, there was nothing there. Until another randomised study using one of those positive secondary outcomes as their primary outcome (e.g. recurrence of low back pain) comes along, we can only conclude that this intervention is ineffective.
“Yes, we observed some effects on those secondary outcomes,” Traeger continued. “We do need to be a bit careful about how we interpret those though. The positive effects could have occurred by chance. Future studies are required before we can confirm if pain education has positive effects on those outcomes.”
Nick Ng is the editor of Massage & Fitness Magazine and the managing editor for My Neighborhood News Network.
An alumni from San Diego State University with a bachelor’s in graphic communications, Nick also completed his massage therapy training at International Professional School of Bodywork in San Diego in 2014. In 2021, he earned an associate degree in journalism at Palomar College.
When he gets a chance, he enjoys weightlifting at the gym, salsa dancing, and exploring new areas in the Puget Sound area in Washington state.
