Anyone with an aching back knows just how debilitating that pain can be. Now, Stanford Medicine researchers may have good news for the 500 million people worldwide experiencing low back pain.
Stanford pain psychologist Beth Darnall, PhD, has developed a single-session, two-hour class called Empowered Relief, which aims to rapidly equip patients with pain management skills. The first randomized, controlled clinical trial suggests this new method may be as effective at reducing chronic low back pain as weeks of other therapies, a paper in JAMA Network Open recently reported.
Empowered Relief stems from a type of therapy called cognitive behavioral therapy, which relies on the interconnection between thoughts, feelings, physical sensations and actions. Both treatments can help patients identify and change thoughts and behaviors that increase their pain, as well as learn coping skills to better control pain response and improve quality of life.
"The problem is CBT isn't broadly accessible," said Darnall. "There are only a small number of behavioral specialists, and yet millions of Americans live with ongoing pain. And many under-served communities in the U.S. don't know how to find a trained therapist."
Another major barrier, said Darnall, is time commitment -- cognitive behavioral therapy patients attend a two-hour group session each week for two to three months.
To address this problem, Darnall combined what she believed were the most critical skills from cognitive behavioral therapy, such as identifying unhelpful and stressful thought patterns, with information about the science of pain, mindfulness principles, and the relaxation response. With the help of an instructor, patients then translate their new skills and knowledge into a personalized plan to manage their pain at home.
"The goal is to align our treatments with what's feasible for patients and make it broadly accessible," Darnall said. It's possible, she said, to teach 85 people in a one-and-done Empowered Relief class. And if taught weekly, 680 patients could be treated in eight weeks, compared with 10-15 who could be treated during that time with cognitive behavioral therapy.
Pain treatment with lasting effects
Darnall conducted the clinical study with Sean Mackey, MD, PhD, professor of anesthesiology, perioperative and pain medicine at Stanford. In it, 263 adults with chronic low back pain -- most of whom had this pain for more than five years and almost half of whom had additional chronic pain conditions -- were randomly assigned to eight cognitive behavioral therapy sessions, one Empowered Relief session or one traditional health education session, which acted as a control. (In health education, participants learned basic information, such as the definition and warning signs of back pain, but not actionable skills or the neurobiology of pain.)
For three months after the treatment, the participants reported information about their pain, such as its intensity and whether it disturbed their sleep. According to patient reporting, Darnall's course relieved pain as effectively as cognitive behavioral therapy and better than the health education session.
"I was pleasantly surprised that people's back pain improved as well as their sleep, depression, and anxiety symptoms," said Mackey. "I can easily see this integrating with standard medical care to provide benefits for many patients."
The results are promising, but the study will need to be replicated in a larger and more diverse population, said Darnall.
The success of the course doesn't mean cognitive behavioral therapy will be eliminated, Darnall said. Instead, the researchers want to determine how to match individual patients with treatment options that work best for them. That, she said, could inform pain treatment protocols, resource allocations and other medical decision-making.
Now, Darnall's team is expanding access to the Empowered Relief program to help address existing disparities in pain care. The class is already available in five languages and seven countries to treat chronic pain -- and the team has certified 300 healthcare clinicians around the world as Empowered Relief instructors.
"I hope expanded, online access to the course will provide more equitable access to evidence-based pain care for people living in rural areas, prisons and other settings that lack trained pain professionals," she said.
Photo by Sasun Bughdaryan