A Goethe University Frankfurt study found that a combined approach works best.
Back pain is a common condition with numerous causes, including poor posture, overexertion, constant stress at work or at home, lack of exercise, and poor posture. For a considerable number of patients, the symptoms are chronic, meaning they last a long period or reoccur repeatedly. However, port and exercise therapy, when done properly, can provide alleviation.
Physiotherapy, as well as strength and stability exercises, are common treatment options. But how can the treatment be as effective as possible? Which method reduces pain the most effectively? A recent meta-analysis published in the Journal of Pain by Goethe University Frankfurt revealed new insights.
The researchers began with data from 58 randomized controlled trials (RCTs) involving over 10,000 individuals suffering from chronic low back pain throughout the globe. The relevant data from the original manuscripts were first filtered out and then analyzed in groups. When analyzing this data, the researchers looked at whether and how conventional forms of therapy and individualized treatment varied in terms of outcome. “Individualized” refers to some kind of personal coaching where therapists precisely target the needs and potentials of each patient and collaborate with them to choose the course of their treatment.
According to the research, individualized therapy for chronic back pain had a much greater impact than conventional exercise therapies. The success rate for pain alleviation was 38% more than with conventional therapy.
“The higher effort required for individual treatment is worthwhile because patients benefit to an extent that is clinically important,” says lead author Dr. Johannes Fleckenstein from the Institute of Sport Sciences at Goethe University Frankfurt.
However, the study went even further. The research team in Frankfurt compared a third group of treatment methods alongside the standard and individualized ones. In this group, individualized training sessions were combined with cognitive behavioral therapy (CBT). This procedure – a type of talk therapy – is based on the assumption that negative thoughts and behaviors surrounding pain tend to exacerbate it. Through CBT, pain patients learn to change the way they handle it.
They stop being afraid to move or are taught tactics for coping with pain. This makes them realize that they are by no means helpless. But what does psychotherapeutic support through CBT actually contribute to the success of the treatment? Analysis of the data revealed the following: When an individualized approach and CBT were combined, the success rate in terms of pain relief was an impressive 84 percent higher than with standard treatment. The combined therapy, also called multimodal therapy, thus led to the best result by far.
Fleckenstein sees in the study “an urgent appeal to public health policy” to promote combined therapies both in terms of patient care and remuneration. “Compared to other countries, such as the USA, we are in a relatively good position in Germany. For example, we issue fewer prescriptions for strong narcotic drugs such as opiates. But the number of unnecessary X-rays, which, by the way, can also contribute to pain chronicity, and inaccurate surgical indications are still very high.”
This is also due, according to Fleckenstein, to economic incentives, that is, the relatively high remuneration for such interventions. The situation is different for organizations working in the area of pain therapy, he says. Although these are not unprofitable, they are not a cash cow for investors either. In his view, it is important here to improve the economic conditions. After all, pain therapy saves a lot of money in the long run as far as health economics are concerned, whereas tablets and operations rarely lead to medium and long-term pain relief.
Reference: “Individualized Exercise in Chronic Non-Specific Low Back Pain: A Systematic Review with Meta-Analysis on the Effects of Exercise Alone or in Combination with Psychological Interventions on Pain and Disability” by Johannes Fleckenstein, Philipp Floessel, Tilman Engel, Laura Krempel, Josefine Stoll, Martin Behrens and Daniel Niederer, 29 July 2022, Journal of Pain.
DOI: 10.1016/j.jpain.2022.07.005
65 Comments
“X-Rays contribute to pain chronicity?” Whoa! That was researched? This fellow calls for CBT sessions for sufferers of back pain? Over 60% of Americans on the couch for back pain? I doubt tis will happen since most of America’s nutcakes can’t get therapy and insurance coverage in the US is not even good enough to be “spotty.” Mental health professionals at Kaiser-Permanente just went on strike because of understaffing. Lastly, these folks have never heard of Chiropractic therapy? This is a gigantic out (of course they could be members of the AMA.)
Knowledgeable post
Chiropractic is THE BEST for back pain and this article doesn’t even mention it, morons
Totally agree. The only time I got massive relief including acupuncture
Chiro is crappo.
ChiroQuackers are not real doctors and are taught, believe, and practice some of the most outrageous and damaging things.
What iQ are you Joe?
You obviously know nothing about Chiropractors! Chiropractors are doctors. They graduate as Doctors of Chiropractic. They go through most of the training Medical Doctors go through in fact in some states they can be your primary doctor. I have Degenerative Disc Disease and using a Chiropractor helps so much with my chronic pain.
This article is Nothing new ! I have a long history of damage. The only thing that has helped me is surgery! Talk therapy may help some!, but most of us are way past there.
Chiropractors rock!!!
Chiropractors and physical therapists go through much more training than you think. Now of course there is a difference on going to a $10 chiropractor at a flea market and going to a professional.
As someone who lives in chronic pain everyday, from 4 failed back surgeries, I can honestly say CBT does not help most people with chronic back pain. The very definition of chronic means long lasting and talking about your pain does not make the pain go away. I have done CBT with indiv. Physical therapy and someone telling me not to be scared of the pain just makes it worse. Imagine waking up everyday and knowing your pain will be there usually at least an 8 out of 10. What makes it worse is taking people’s pain medicine away because then they can not fight it. The very best thing for back pain is movement and without medication movement isn’t possible.
I’ve been an Army medic, pharmacy technician, civilian medic and am a surgical technologist, and also for 29 yrs have practiced neuromuscular/advanced clinical massage therapy. For the vast majority of people with back pain where the cause is due to muscle spasm and imbalance, pelvic stabilization stretching and myofascial techniques work! The problem is that there aren’t enough therapists who are truly knowledgeable in functional anatomy,kinesiology,pathologies and have treated enough cases under medical direction to be thorough enough in evaluation and treatment. It’s not checkers it’s chess, but it’s not “rocket surgery” either.
I’ve enjoyed being tertiary care and provided relief after other attempts have come up short. Find a good neuromuscular therapist, preferably one with a medical backround and 10+ experience and they should get you back to enjoying life.
Chiropractors are just glorified masseuses. But since we’re talking chronic back pain, there are legitimate injuries which do require pain medication and or surgery. Herniated discs, neural stenosis along with severe disc protrusion are some examples. Surgery is always a last resort but it depends on the person and their medical history. Oh yea, the writer said poor posture twice. Hahaha
I have found that acupuncture and an exercise program works best for me.
Pain may have a common starting point for everyone, but everyone’s experience with it is unique to them and their treatment should be also. This one size fits all approach is BS. Just because a treatment works for the “majority of people in the study” doesn’t mean it’s going to work for me.
Totally agree. The only time I got massive relief including acupuncture. Incidentally doctors are taught Joe.Great chiropractors and bad, same as with doctors. Just my opinion.
Unless you have the best health insurance going, no one could easily afford such multi-modal treatment. The US citizens are in an even worse situation because healthcare there is based on profit motive. The doctors want a steady income stream.
In Canada, where I live, most doctors have a turn-key flowchart approach. Nothing is ever personalized. They all get paid about the same whether they do a good job or not and try schedule as many people in a day as they can to maximize profits.
My wife has the chronic back pain and has tried chiropractic treatments, massage, and physio. Nothing works for very long.
I’m 64 pulled my back out first time in the 80s. Have had trouble ever since. MRIs,chiropractors,opiates,xrays.Declining any operations. Exercises and stretching is the best thing to do.
Inversion works.
Find a Dr. who is trained on the Boston Scientific RFGenerator. It will stop nerve pain in seconds. I have had it done from my head down to S4. At least 60 times in the last 5 years. Got my life back.
Chiro can give great symptom relief – but does nothing to fix the body. You go, and feel better, so believe it helps. This is because the joint movement gives temporary down-regulation for pain reception in the nervous system.
Appropriate exercise can help with encouraging tissue adaptation.
CBT type therapy can help to re-train the nervous system and down regulate pain.
Spinal Decompression works wonders. This is FDA approved. I have several lumber disks that have herniated due to a work injury.
Having gone through 8 treatments of Spinal Decompression with amazing results of a constant pain level of 7-8 being reduced to 2-4 from this treatment !!
This certainly is a treatment that should be covered through our Health Insurance and is not.
Considering the cost of surgeries… medications…. and constant ongoing treatments that still in many cases leave a injured person with ongoing chronic pain.
Do some research on a chiropractors education!! You might learn something because your obviously not very smart!!
I wàs diagnosed with a spinal Lipoma when I was 29 years, without my surgery to partially remove some of the tumour and to ultimately reduce my ongoing pain. Now I have been taking morphine sulfate injection for 30years. I am 66years with only my right leg trying my hardest to do regular physio with my trainer.
I was in a life threatening accident. I fell down 15 steps in my home. I needed what I now call” a simple back fusion” I went into the hospital after having over 100 back injections PT,Acupuncture, wearing a back brace, I woke up 1 day abd I literally couldn’t move. Called my back Dr/ surgeon. He said met me at the hospital I’ll be waiting for you in the OR. SO NO PROBLEM RIGHT??? WRONG!!! I don’t even remember being in the hospital not 1 day. I was there for I think about 8-10 days. I remember NOTHING! The night I was released the nurses told my husband that they gave me more medicine for the long drive home. He was livid. He told them” Can’t you all see she can’t even walk on her own, can’t talk to communicate, she’s so drugged up already. What’s wrong with all of you?” Well, as soon as we got home I was put in my bed. Woke up at 4am to go to the bathroom. All I remember is yelling HELP! I FELL LIKE THE STATUE OF LIBERTY ON MY FACE. MY HUSBAND CALLED 911. I WAS TAKEN TO A LOCAL HOSPITAL. I WAS THERE FOR 7 DAYS. TURN TRANSFERED TO JOHN’S HOPKINS HOSPITAL. THE HOSPITAL THAT HAVE ME THE DRUGS OVERDOSED ME. I’VE HAD OVER 50 SURGERIES,I STILL CAN’T WALK, NOBODY WILL HELP ME TO FIX MY BACK NOW. ALL THE HARDWARE IS BROKEN. I’M IN HORRIFIC PAIN 24/7. THIS SO WASN’T MY FAULT. IT WAS THE HOSPITALS FAULT. I HAS 3 SKULL FRACTURES, BROKE EVERY BONE IN MY FACE, SO MY FINGERS MY LEFT KNEE WAS BROKEN. I’M TOTALLY BEDRIDDEN NOW. MY LIFE WAS TAKEN FROM ME APP FROM AN “ACCIDENTAL OVERDOSE” REALLY??? I DIDN’T KNOW WHO I WAS FOR OVER 2 YEARS. I COULDN’T EVEN GO AFTER THE HOSPITAL SINCE YOU ONLY HAVE 2 YEARS. I WAS PAST THE STATUE PF LIMITATIONS. THAT’S BS! THRU JUST ABOUT KILLED ME. I WAS A VERY ACTIVE WOMEN. WORKED OUT 6 DAYS A WEEK, WALKED 10 MILES A DAY WITH WRIST AND ANKLE WEIGHTS. SO UNLESS YOU’VE WALKED IN MY SHOES DON’T TELL ME ABOUT HAVING BACK SURGERY AND DOING WHAT YOU’VE SUGGESTED. I TRIED EVERYTHING THAT YOU MENTIONED. TILL I COULDN’T MOVE AND WAS RUSHED TO A HOSPITAL 3 HRS AWAY. AFTER BEING IN THE ICU FOR 7 DAYS JUST LAYING THERE AND THEY DID NOTHING. MY NOSE WAS UP INSIDE OF MY SKULL. ALL FROM HAVING WHAT I NOW SAY IS A SIMPLE BACK FUSION. THE WOMEN WHO COMMENTED PRIOR TO ME IS SO RIGHT IN EVERY WAY. I WOULD PRAY FOR THE LORD TO HELP ME GET WELL. NOW I PRAY FOR HIM TO LET ME GO HOME. I HAVE NO LIFE. I’M ONLY EXISTING. JUST LAYING IN A BED WAITING TO DIE. SO YOUR RECOMMENDATION ISN’T FOR EVERYONE. I’VE HAD 3 BACK SURGERIES PRIOR TO THIS ONE. THEY ALL WORKED FINE. THIS ONE I COULDNT TELL YOU OF IT WOULD OF WORKED. I ALMOST DIED BEFORE I EVEN HAD A CHANCE TO KNOW. SO YOU TELL ME WHY NOT 1 DR WILL HELP ME AND FIX MY BACK THAT IS SHATTERED??? I’VE SEEN 6 SURGEONS NOT 1 WILL TOUCH ME. MY HEART GOES OUT TO EVERYONE THAT DEALS WITH BACK PAIN OR ANY OTHER PAIN 24/7. THIS COULD OF BEEN PREVENTED. SENDING PRAYERS TO EVERYONE.
After two neurosurgeons recommended a5 pint fusion with neuropathy relief,just stabilization. I found spinal decompression therapy. After 6 treatments and starting to do back strengthening exercises I have found major relief and feeling like I can get my life mostly back
Jennifer Jones I totally agree with you. I’VE had 2 back surgeries. The only way I can function and move is pain medication. I deal with 8 to 10 level of pain everyday. Pain management doctors don’t listen to the patient’s telling them how they feel.The people that abuse opiates makes it hard for people who use them properly. Without them I wouldn’t be able to walk or move.
After being misdiagnosed with “sprained back” for 23 years, I can say the only thing that has helped is a great Chiropractor and some pain meds and muscle relaxers to get me through the crunch. With stage 4 scoliosis and three bad discs, CBT is the joke! Never has done s*** for me, ever, with anything.
Talk Therapy, like talking your excruciating chronic back pain away..😂😂😂 20 years of chronic back pain I been dealing with , 3 back surgery , injections, pills, physical therapy etc, no long lasting results until I got Spinal Cord Implant surgery, my life is now awesome. Went from walking with a cane to walking with my youthful swagger back keep listening to these fly-by ideas that snakeoil professionals pull from the deepest part of their @sshole. SPINAL CORD STIMULATOR made so much of my excruciating daily life altering pain disappear
Iam a 55 year old male living in the USA, your aproach is on point,
I had chronic back pain for 8 years now, and after trying almost everything, i decided to give up my pain meds, and started on Symbalta which is a anti depreasant that works a bit diffrent when it comes to pain.
I started to take a more holistic aproach, i started eating better, low sugar, more veggies high protein diet, also swimming, in combination with total body strenghtening,and yoga, at the same time I started seeing a physchologist to adress my personal issues, and also started biofeedback theraphy.
Finally im doing stretch theraphy.
Its been two months and I wouldnt say im pain free but almost there.
I wish of done this a long time ago. Highly recomment it.
It works. It’s not a panacea, but if you stop poo-pooing it and give an honest shot instead of spending time and energy not accepting it, you will find help. I have 7 bad discs, a genital problem in my feet that is painful and disabling, and I could use a hip and knee replacement. The program helped me get and stay off opioids. The program may oversell itself, but ignoring it will not help you. And please, chiropractic? Not for serious problems https://unlearnyourpain.com/
Love chiropractic care for lower back . It really works if u have a good chiropractor
Chiropractor left me with severe pain for 18 months. He treated my spine as though I was on an assembly line where everyone was considered to have the exact same issues I’m improving but will always have discomfort. If you WANT to be a a victim of Big Pharma you’ll want to stay in the USA
This is why people hate the USA So many fools here in the US and so little hope
DMSO is the strongest and quickest acting pain relief I’ve ever tried. It is AMAZING! You can but it in cream or gel 70% form, which I recommend for starting off.
The 100% liquid version is much stronger but you’d want to apply a thick oil like caster bean oil first to your skin.
Make sure you’ll applying over clean skin. I also tried the roll-on and it’s pretty strong. Apply oil first if you use that one.
I used to go to a pain clinic for 25 years. I fired them. This has helped everyone I’ve told about it. I hope it helps you. Look up 60 Minutes story on DMSO.
Life changing stuff for those in pain.
My chiropractor suggested I may have multiple sclerosis and he was right. You need to find the right one.
I talked with my Dr he told me I need meds and shots and more surgical procedures.I talked to my insurance provider they talked and said it will be this much $$$$$$$.Than I talked with my bank.They stopped talking to me.As of today back hurts,pockets lighter and nobody to talk to.
I found targeted cortesoid injection plus deep tissue massage therapy to relieve 98 percent of 2 years of agonizing sciatica pain.
After 43 years as a Chiropractic and Acupuncture Physician I have successfully treated over 10,000 patients with
Back pain. Every day I see it transform patients lives.
Chiropractic is the only thing that has worked for me what they also have a new technology out it is called electroids it comes in a small compartment such as a heart monitor that fits in your pocket and you put the leaflets of the electroids on your back where your back is hurting and it kills the nerve ending a very good and smart tool for back problems
When I was 31 my Chiropractor said I HAD to have back surgery. I said I would be on a stretcher before we talked about that. My pain ran down my leg and I could not get up off the floor. I soon after discovered inversion. I haven’t been to a chiropractor in 40 years now. I still use it when I feel the pain start. Few minutes a couple times and I’m good again. Inversion may not be for everybody but it was a lifesaver for me.
Pain Free by Pete Egoscue. This is the only thing that isn’t a bandaid.
Thanks a lot ! The Govt must believe your BS! Cause now I have to do PT so I can get an ephideral. I’ve done PT on & off for over 11 yrs. It does Nothing to help my chronic pain. Just costs me more $$ & aggrivation!
Jennifer I totally agree and I wish you luck?
Great read!! Thanks for sharing such a great blog.
The idea that you can think your way out of pain is insulting as it is dangerous. This WRONG view of pain perpetuates the cowardice of doctors to treat pain with medication. We have enough information to know that the “overdose crisis” does one thing well…it permanently disabled me. I hope people fight for their health because doctors are not upholding their oath. They seem stuck to a screen for your visit & want you to meditate your way thru pain. Imagine going thru all those teachings that lead you to possibly help others, but you’re too scared to prescribe pain medication. The number of people who I have known who committed suicide due to pain negligence by a human that dare call themselves health care providers.
Totally agree!!
Boron at least 15 mg a day works in less than a week everyone who uses it gets good relief.
There is a Dr. Jerome Fryer, on Vancouver island BC, Canada that has done his own experiments. He developed simple exercise that rejuvenate back joints. He found that by bending a certain way plasma flows into the joints increasing the nutrients by 20 to 50 times. The inflow time is about 3 seconds.
I applied the process to knee joints bending them sideways. Works like a charm.
My gripe is with the over prescribed medication. It’s the Dr’s who write out the scripts that are most at fault for the opioid crises. I dont think they have any idea how strong the meds are or aren’t. If I took my meds the way there written I’d be comatose or feeling way too good. Yes there are days I need the recommended dosage but not always and it’s then I take less. I read how some do all kinds of therapy. With my income I gripe if I have to take of work for my routine Dr visit. I can’t afford the gas it takes to go to physical therapy. My neurologist wants to operate. I’ll fix you right up. I’m sorry I find that hard to believe. Plus how can I take off for surgery and recuperate. Who’s going to pay my bills while I’m off work or take care of me while I’m laid up. So I take Lyrica which helps me tremendously along with a small dose of hydrocodone. And you have to move. A body in motion stays in motion. Sometimes I feel like my lower body doesn’t want to support my upper half. Lol I have ddd, sciatica bulging disc,spinal stenosis, etc.
There is one thing though and when I tell my dr,Drs, they look at me weird. My hips ache inside, I had this issue long before any of the others. Does anyone know what I’m talking about?
The Electro-Equiscope is the new standard in advanced Electro Therapy for pain and inflammation.
I have suffered for 20yrs. Chronic pain is the worst. Some doctors here in Arizona, know what works and want you to have a good quality of life but then there are the ones who don’t know what it’s like. Pain meds, why do you need that. They’re addictive. No s***, so is soda, coffee, etc. Some day they might figure out what works. Not in my life time
For a person who was struck down so early in life I struggled to walk again, After the driver of our vehicle travel to 110 miles an hour on a left banking turned that he did not know and never made it the car was split in half the Pole was put in half people died anyway let’s move on they told me I would never walk again multiple broken bowels legs put together with rods and coin and body cast and wheelchairs I walked again My point is this people the best thing I have learned for chronic pain is moment your body must stay mobile
Contrast fomentation hydrotherapy helps me plus massage. Heated wet towel applied to back 5 mins. Then cold water rub on back 1 minute. Tis is done 3 times. Then 5 minute back massage with coconut oil. Much relief by stimulating blood flow to area & muscle massage.
After reading the book “Healing Back Pain” by an NYU orthopedist, I realize so much of back pain comes from stress and psychological trauma.
Working to reduced the effects of those helps immeasurably (meditation, breath work, etc)
Why has it taken the CDC and those beneath you, so long to not only release this data but make a nation wide admission that you were a wrong. To admit the torture you caused upon thouumds upon thouumds
Of Veterans, disabled Veterans, American citizens of all classes and the elderly, who suffered daily untill their painful death. You should be tried for crimes to humanity and suffer for your crimes behind bars for life. The very least you should do is lake mulitple televised stating your horrible crimes, send out large banners telling hospitals, Doctors and nurses, it ok to come down from your high horse and start treating Americans in pain, nation wide and make a institution that follows these Doctors, nurses who seem to think they are better, as hospitals, especially ER’s who are known for their self righteous treatment of patients.
E-mails should be sent out nationwide as well al internet and major news papers. Your crime is high. So should your attempt to make it right for those who survived your inhuman crime. Sincerely Steven Alexander (325) 320 0882, 382 Sugarloaf Ave. Abilene Texas 79602. 100 % Disabled Veteran and 34 year veteran of ICI, CCU, CVC, NEONATAL ICU , ER and Mobile ICU.
Why isn’t massage mentioned? I have helped several people that said that PT and Chiropractors didn’t! Also getting a massage is a lot more pleasant!
I have had severe back pain for years doctors don’t do anything but continued appointments to bill my insurance and chiropractor put me in hospital for 2 weeks wish there was something
Chiropractic is Bone Rattling, period.
I agree that Chiro does not work. I spent years of treatment only to have the pain worsen and caused further damage to the injury damage. CBT? In your dreams – literally. Movement plus meds keeps me somewhat active, but the breakdowns due to age are real and unavoidable.
A simple acceptance that there is only so much medicine can do. Medicne is a “practice” and constantly subject to frequent change, both in belief and application.
I have lived with chronic back pain for nearly 10 years. My pain scale is usually 8-10 daily. The opiod epidemic which has Doctors cutting back on pain meds or taken us off of our them has caused us to suffer unnecessarily. I do not want to live like this this the rest of my life. I am NOT addicted to pain meds. I am just trying to take only what I need so I am comfortable.
Doctors should be more empathic with patients. They treat us as drug addicts. I don’t want to take pills. If I do anything I need a pain pill.
Chiropractic is wonderful. It’s the only thing that has ever helped along with strength training.
All these people saying they didn’t even mention chiropractic treatment but they didn’t mention any kind of treatment other than treatment styles. Chiropractic treatment could be the individualized treatment they were talking about.
Chiropractors are not always the best! Needling helps, acupuncture and daily exercise . Also, keeping a healthy slim weight definitely helps take pressure off of back. A plant based diet! Vitamins! Cryotherapy,Cbd and legalize marij.for good already to get these people relief !