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.
Key words
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Article info
Publication history
Published online: December 25, 2022
Accepted:
December 18,
2022
Received in revised form:
December 14,
2022
Received:
September 16,
2022
Publication stage
In Press Journal Pre-ProofFootnotes
GLM has received support from: Reality Health, Connect Health UK, Kaiser Permanente, AIA Australia, Workers’ Compensation Boards and professional sporting organizations in Australia, Europe, South, and North America. Professional and scientific bodies have reimbursed him for travel costs related to presentation of research on pain and pain education at scientific conferences/symposia. He has received speaker fees for lectures on pain, pain education and rehabilitation. He receives royalties for books on pain and pain education, including three books used in, or directly relevant to, the RESOLVE intervention.
The remaining authors have no conflicts of interest to disclose.
The trial was funded by the National Health and Medical Research Council of Australia (ID1087045). RRNR is supported by the University of New South Wales School of Medical Sciences Postgraduate Research Scholarship and a NeuRA Ph.D. Candidature Supplementary Scholarship. He received fees from the 2021 Allied Health Cross Boundary Grant Stream to deliver a workshop that involves pain science education. BMW has received speaker's fees for talks on the rehabilitation of chronic pain problems. HBL is supported by a Leadership Investigator Grant to GLM from the National Health & Medical Research Council of Australia (ID1178444). ETOH has received funds from an Australian Commonwealth Government Research Training Program Scholarship and a NeuRA Ph.D. Candidature Supplementary Scholarship. MKB has received fees to speak about pain neuroscience and rehabilitation, and engagement with research evidence.
ACT has received funding from the Australian National Health and Medical Research Council (NHMRC) including an NHMRC Early Career Fellowship (APP1144026) and funds from an NHMRC Program Grant (APP1113532) entitled ‘Using healthcare wisely: reducing inappropriate use of tests and treatments. SMG is supported by a Research Fellowship from the Rebecca L. Cooper Medical Research Foundation. GLM is supported by a Leadership Investigator Grant from the NHMRC of Australia (ID 1178444). SS is supported by an International Association for the Study of Pain John J. Bonica Postdoctoral Fellowship. AGC is supported by an Emerging Leadership Grant from the NHMRC of Australia. JHM received grants from the National Health and Medical Research Council of Australia related to the RESOLVE trial (grant number 1087045 [from 2015-2020]).
Identification
Copyright
© Published by Elsevier Inc. on behalf of United States Association for the Study of Pain, Inc.
