Sensorimotor training: could the answer to back pain lie in reprogramming our brains?

Name: Chronic back pain.

Age: Ancient, probably. I bet hunter-gatherers grubbing for berries and sleeping on cave floors suffered.

Remedy: Possibly brain-based?

This had better not be some “pain is psychosomatic” nonsense. Sorry, what did you say? I can’t hear you down there.

Hang on, give me a minute to sit up. Oof. Ouch. Oh, are you among the one in six adults in the UK with back pain? You’ll be interested in this: a new Australian study suggests brain training can bring real relief to sufferers.

It takes a brave scientist to suggest back pain is all in the mind. They’re not saying that. But we do need to explore new strategies, because (some of) the drugs don’t work. Research reported in May claimed two anti-inflammatories commonly prescribed for back pain, diclofenac and dexamethasone, could prolong the problem, possibly by interfering with the body’s natural healing processes.

They will have to fight me for my Voltarol. You’re walking like an injured crab, so I don’t think that would be too hard. But the real point is that retraining the way the brain and body communicate with each other appears to bring real relief to chronic sufferers.

How does it work? The theory is that the brain’s map of the body gets “smudged”, meaning sufferers’ pain systems becomes hypersensitive. Physiotherapists put people with long-term lower back pain through a 12-week “sensorimotor” retraining programme to address that.

A what now? They started out using exercises such as showing participants pictures and asking them to identify if the people in them were turning left or right. Magically, that activates the same neural pathways as actual movement. Later, they moved on to exercises such as lunges and squats.

And that worked? It did! Those on the sensorimotor programme reported a decrease in pain on average from 5.6 to 3.1 on a scale of zero to 10. “People were happier, they reported their backs felt better and their quality of life was better. It also looks like these effects were sustained over the long term,” said Prof James McAuley of the University of New South Wales.

How robust is this research? It was a small trial – 276 participants – but a randomised controlled one, so a control group got “sham” treatments, such as lasers.

Lasers! They sound cool. They don’t work. But the control group’s reported pain fell slightly from 5.8 to 4.0. Of course, the placebo effect is just more evidence how mysterious the brain-body connection is.

Do say: “The miracle of brain plasticity means I can train myself to feel less back pain.”

Don’t say: “So, soon I’ll be fighting fit to tackle anyone who says it’s all in my head.”


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