Ab. No. 16 Exercises and Pain Education Improves Clinical Outcomes in a Subgroup of Patients With Chronic Low Back Pain Positive for Central Sensitization

Abstract

Introduction: Exercises have been found to decrease pain and the overall sensitivity of the central nervous system through the activation of exercise-induced endogenous analgesia and spinal inhibitory mechanisms. Despite the recommendations of many reviews that exercise programs reduce pain and disability in persons with chronic pain, the overall confidence is considered ‘critically low’. This study aimed to evaluate the effect of different exercises (aerobic, motor control, and superficial strengthening) relative to patient education on pain sensitivity and clinical outcomes in patients with chronic non-specific low back pain (NSCLBP) positive for central sensitization. Methods: The trial is a randomized controlled study with concealed allocation and blinding of assessors with four experimental groups (n=172) and one healthy control group (n=43). Participants were engaged in moderately intense treadmill walking sessions, activities for trunk stabilization, and strengthening exercises for the trunk and abdominal muscles along with patient education as per their group allocation. The control group received only patient education. The primary outcome was the cold pressor test. The secondary outcomes were pain intensity, disability, letter-number sequencing subtest, Stroop neurophysiological test, quality of life, and isometric muscle strength of the spine and hip muscles. Measures were taken at baseline and 12 and 24 weeks. Result: The results showed that patients with CLBP exhibit impaired CPM relative to healthy volunteers even after the intervention period. The overall results of the study showed improvement with time, and there was no difference between the groups in improving outcomes (p > 0.05). There was a small effect size in favor of groups that received exercise and patient education (<0.15) over the control group. Conclusion: Considering the comparable effects on clinical outcomes in patients with NSCLBP, this population may be encouraged to undertake exercises of moderate intensity of their preference.