Artikel
Pain education for patients with acute low back pain at high-risk of poor outcome: the PREVENT randomised, placebo-controlled trial
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Veröffentlicht: | 6. März 2018 |
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Background/Objective: It is unclear whether patients with acute low back pain who are at high risk of a poor outcome benefit from referral for additional support. We aimed to determine the efficacy of referring patients with acute low back pain, who are at high risk of a poor outcome, for 2 hours of pain education with a physiotherapist.
Methods: Primary care practitioners referred 618 potential participants. We included 202 participants with low back pain of less than 6 weeks’ duration who had a high risk of developing chronic low back pain according to ‘PICKUP,’ a validated prognostic model. All participants continued to receive care from their usual practitioner, consistent with guidelines. We randomised participants to two additional 1h sessions of Pain Education (pain education which included information on the nature of pain and biopsychosocial contributors plus self-management techniques such as remaining active and pacing) or Placebo Pain Education (active listening, no information or advice) and followed them up at 1 week, and at 3, 6 and 12 months. Retention was 96% at the primary endpoint of 3 months.
The primary outcome was pain intensity (11-point Numeric Rating Scale) at 3 months. Pain was also assessed at 1 week, 6 months, and 12 months. Secondary outcomes included disability (24-point Roland Morris Disability Questionnaire), development of chronic low back pain, recurrence rate, depressive symptomatology, reassurance, and healthcare utilisation.
Results: Pain Education was not more effective than Placebo Pain Education at reducing pain intensity (3-month mean pain intensity for Pain Education group = 2.1 (SD, 2.4), and for Placebo Pain Education group = 2.4 (SD, 2.2), mean difference [95% confidence interval] = -0.3 [-1.0 to 0.3]). There were benefits of Pain Education on some secondary outcomes. The odds of recurrence in the Pain Education group was less than half that of the Placebo Pain Education group (odds ratio 0.44 [0.24 to 0.82]).
Conclusions: Adding 2 hours of intensive pain education to guideline care for patients with acute low back pain at high risk of poor outcome was no more effective than placebo. Although there may be some benefits of pain education, including reduced odds of recurrence, our findings do not support the addition of intensive pain education to high quality guideline care provided by primary care practitioners.
Trial Registration ANZCTR 12612001180808