text_1: Overcoming Fear of Back Pain May Spur Recovery
text_2: This article, based on findings of a small study of people with chronic back pain in Belgium reported in the journal JAMA Neurology, tells readers that if they can only “think differently” and stop “fearing” their pain, such attitude changes combined with “cognition-targeted motor control training” does significantly more than standard physical therapy and back pain “education” to reduce the pain and increase ability to function. The problem is that the story doesn’t really explain the differences between the standard and experimental therapies, the latter of which is composed of a sort of physical “desensitization” to feared physical movements; and fails to offer any details about the base level of the subjects’ pain, how pain was measured, or why the researchers looked for (and didn’t find) brain changes in the study group. We were glad the article included an outside expert, who makes clear that the experimental intervention is time intensive, costly, not covered by insurance and  — although “promising” — still unproven with respect to long-term benefit compared to standard therapies. That provided some much needed information for the reader. (Note: Due to an editing error, this story originally was marked with a 2-star score. It has been updated to reflect the correct rating of 3 stars.) This study focuses on behavioral and educational approaches designed to reframe how patients think about their pain. By emphasizing that “hurt doesn’t mean harm,” the hope is that patients will become more active and that activity may actually reduce pain. This “pain catastrophizing” theory is not really new. As such the description of this study doesn’t make clear what is different from prior studies evaluating this approach. Nonetheless, such efforts are important and need to be replicated in larger studies, so were glad the story ended on that note.