Comparisons of the effects of psychologically-informed and usual physiotherapy on pain sensitivity in chronic low back pain: an exploratory randomized controlled trial.
Hugo Massé-Alarie, Amélie Desgagnés, Claudia Côté-Picard and 4 others
PMID 39974748WHAT IT FOUND
Both approaches made people with chronic low back pain less sensitive to pressure after six weeks; adding psychological strategies to usual physiotherapy made no difference.
Pain and disability improved in both groups. Without an untreated comparison it is unclear how much came from treatment.
Key findings
01Pressure pain thresholds rose at the lower back, the leg and the wrist over six weeks in both groups, with no difference between psychologically-informed and usual physiotherapy.
02The one group difference the statistics picked up, for repeated pinprick pain at the wrist, did not hold up: direct comparisons at baseline and at six weeks, and the change within each group, were not significant.
03Three of 27 analyses pooling both groups linked pain sensitivity to physical functioning: a 1 kg/cm² rise in back pressure pain threshold went with a 2.36% lower disability score, and a 1-point fall in repeated pinprick pain at the back or the leg went with a 3.50% and 3.10% lower disability score. Nothing was linked to pain intensity.
STILL TO COME
How it was doneWhat they foundWhat it means for PTs
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What it does not show
Only 40 people were randomised and 35 were followed up, with no sample size calculation, so the study was too small to rule out a moderate difference between the two approaches. There was no untreated or minimal-intervention group, so it is impossible to tell whether the rise in pressure pain thresholds came from the treatment or from the natural course of the condition. Pressure pain thresholds can also rise simply because the same test is repeated, as the authors point out. The two treatments were delivered at two different clinics by different physiotherapists, so any difference between the groups could reflect the therapists rather than the treatment. The groups differed at the start: the usual physiotherapy group scored higher on pain catastrophizing. Only 3 of 27 regression analyses were significant, which may be chance given how many were run, and because both groups were pooled no single approach can be credited with the association. Sensory testing was repeated only at six weeks, which is short for a long-term condition.
Declared interests
The project was funded by a grant from REPAR, the rehabilitation research network of the Fonds de recherche du Québec. One author is supported by a research salary award from the Fonds de recherche du Québec – Santé. The authors declared no conflicts of interest. The funder had no role in the study design, data collection and analysis, the decision to publish, or writing the manuscript.
The easy way to misread this
Do not read the rise in pressure pain thresholds as proof that physiotherapy desensitises the nervous system. There was no untreated comparison group, the two groups were treated at different clinics by different physiotherapists, and the authors note that thresholds can rise simply on a second test. Equally, the one group difference the statistics flagged, for repeated pinprick pain at the wrist, did not hold up when the two groups were compared directly, so it is not evidence that psychologically-informed physiotherapy works better.
Summarised by AI from the full paper, without a clinician reviewing it. Check it against the source before it changes what you do. Read it on PubMed →