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“My Back is Fit for Movement”: A Qualitative Study Alongside a Randomized Controlled Trial for Chronic Low Back Pain

  • Rodrigo R.N. Rizzo
    Correspondence
    Address reprint requests to Rodrigo RN Rizzo, MSc, School of Health Sciences, Faculty of Medicine, University of New South Wales, Sydney, NSW, 2031, Australia.
    Affiliations
    School of Health Sciences, Faculty of Medicine, University of New South Wales, Sydney, Australia

    Centre for Pain IMPACT (Investigating Mechanisms of Pain to Advance Clinical Translation), Neuroscience Research Australia, Sydney, Australia
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  • Benedict M. Wand
    Affiliations
    School of Health Sciences and Physiotherapy, The University of Notre Dame Australia, Fremantle, Australia
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  • Hayley B Leake
    Affiliations
    Centre for Pain IMPACT (Investigating Mechanisms of Pain to Advance Clinical Translation), Neuroscience Research Australia, Sydney, Australia

    IIMPACT in Health, University of South Australia, Kaurna Country, Adelaide, Australia
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  • Edel T. O'Hagan
    Affiliations
    Centre for Pain IMPACT (Investigating Mechanisms of Pain to Advance Clinical Translation), Neuroscience Research Australia, Sydney, Australia

    Prince of Wales Clinical School, University of New South Wales, Sydney, Australia

    Westmead Applied Research Centre, University of Sydney, Sydney, Australia
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  • Matthew K. Bagg
    Affiliations
    Centre for Pain IMPACT (Investigating Mechanisms of Pain to Advance Clinical Translation), Neuroscience Research Australia, Sydney, Australia

    Curtin Health Innovation Research Institute, Faculty of Health Sciences, Curtin University, Perth, Australia. Perron Institute for Neurological and Translational Science, Perth, Australia
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  • Samantha Bunzli
    Affiliations
    School of Health Sciences and Social Work, Griffith University, Nathan Campus, Queensland, Australia

    Physiotherapy Department, Royal Brisbane and Women's Hospital, Queensland, Australia
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  • Adrian C. Traeger
    Affiliations
    School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
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  • Sylvia M. Gustin
    Affiliations
    Centre for Pain IMPACT (Investigating Mechanisms of Pain to Advance Clinical Translation), Neuroscience Research Australia, Sydney, Australia

    NeuroRecovery Research Hub, School of Psychology, University of New South Wales, Sydney, Australia
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  • G. Lorimer Moseley
    Affiliations
    IIMPACT in Health, University of South Australia, Kaurna Country, Adelaide, Australia
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  • Saurab Sharma
    Affiliations
    School of Health Sciences, Faculty of Medicine, University of New South Wales, Sydney, Australia

    Centre for Pain IMPACT (Investigating Mechanisms of Pain to Advance Clinical Translation), Neuroscience Research Australia, Sydney, Australia
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  • Aidan G. Cashin
    Affiliations
    School of Health Sciences, Faculty of Medicine, University of New South Wales, Sydney, Australia

    Centre for Pain IMPACT (Investigating Mechanisms of Pain to Advance Clinical Translation), Neuroscience Research Australia, Sydney, Australia
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  • James H. McAuley
    Affiliations
    School of Health Sciences, Faculty of Medicine, University of New South Wales, Sydney, Australia

    Centre for Pain IMPACT (Investigating Mechanisms of Pain to Advance Clinical Translation), Neuroscience Research Australia, Sydney, Australia
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Published:December 25, 2022DOI:https://doi.org/10.1016/j.jpain.2022.12.009

      Highlights

      • Facilitators/barriers to target the altered nervous system in chronic low back pain.
      • Effective pain communication creates positive attitudes and empowerment.
      • Some approaches increase while others interfere with intervention coherence.
      • Face-to-face and online components increase confidence in performing the treatment.
      • People outside the treatment team also impact the acceptability of the treatment.

      Abstract

      A new wave of treatments has emerged to target nervous system alterations and maladaptive conceptualizations about pain for chronic low back pain. The acceptability of these treatments is still uncertain. We conducted a qualitative study alongside a randomized controlled trial to identify perceptions of facilitators or barriers to participation in a non-pharmacological intervention that resulted in clinically meaningful reductions across 12 months for disability compared to a sham intervention. We conducted semi-structured interviews with participants from the trial's active arm after they completed the 12-week program. We included a purposeful sample (baseline and clinical characteristics) (n = 20). We used reflexive thematic analysis informed by the Theoretical Framework of Acceptability for health care interventions. We identified positive and negative emotional/cognitive responses associated with treatment acceptability and potential efficacy, including emotional support, cognitive empowerment, readiness for self-management, and acceptance of face-to-face and online components designed to target the brain. These findings suggest the importance of psychoeducation and behavior change techniques to create a positive attitude towards movement and increase the perception of pain control; systematic approaches to monitor and target misconceptions about the interventions during treatment; and psychoeducation and behavior change techniques to maintain the improvements after the cessation of formal care.

      Perspective

      This article presents the experiences of people with chronic low back pain participating in a new non-pharmacological brain-targeted treatment that includes face-to-face and self-directed approaches. The facilitators and barriers of the interventions could potentially inform adaptations and optimization of treatments designed to target the brain to treat chronic low back pain.

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