Treating Chronic Low Back Pain: Then and Now
Over 20 years ago, a group of researchers led by T. G. Mayer, M.D. proposed a new approach to chronic low back pain (LBP). The focus moved away from bedrest to a more active treatment approach. The new program was called a functional restoration program.
Instead of avoiding activities, patients were advised to follow a program of exercise to restore function. The goal was to return to work by overcoming deconditioning from inactivity. Workers participated in a program 57 hours each week.
Psychologic needs of the patients were also included in the functional restoration program. Personal and family counseling was provided. Pain management using relaxation and guided imagery was also included.
The results of this work were published and received the 1985 Volvo Award for Research in Back Pain. In this current article by James Rainville, M.D., the work by Mayer and associates is reviewed.
The authors reflect on changes that have taken place in the care of chronic LBP patients as a result of the original Mayer article. The Mayer group clearly changed the way chronic LBP was managed. Better health was reported and more workers returned to work than ever before.
Our current health care system includes a work disability program that does not support the functional restoration program. Even so, when used with chronic LBP patients, the number of sick days is reduced.
Working through the pain can reduce back pain. But even if it doesn't, physical function is improved. Disability is reduced. Mayers' group showed that vigorous exercise does not make chronic LBP worse.
Helping patients overcome their ideas about what they can and can't do was a new approach 20 years ago. Today, it is a core value in the care of LBP.
James Rainville, MD. A Review of 1985 Volvo Award Winner in Clinical Science: Objective Assessment of Spine Function Following Industrial Injury. In Spine. August 15, 2007. Vol. 32. No. 18. Pp. 2031-2034.