Is this the missing piece in chronic pain care?
Key Takeaways
Industry Buzz
“I expect a move toward multimodal pain management strategies that lean less on opioids and more on targeted therapies.” — Luis Vinas, MD
Current guidelines from bodies such as the World Health Organization remain cautious about endorsing lifestyle interventions for lower back pain (LBP), primarily due to the limited availability of high-quality evidence. However, research increasingly recognizes the benefits of integrating lifestyle interventions into routine clinical practice for complex chronic conditions, including LBP.
Encouraging trial results
A recent randomized clinical trial published in JAMA Network Open assessed the efficacy of integrating lifestyle care into standard LBP management, demonstrating superior outcomes compared to guideline-based physiotherapy alone.[]
Researchers at the University of Sydney randomly allocated 346 adults with chronic LBP and at least one modifiable lifestyle risk factor (eg, being overweight, smoking, poor dietary habits, and physical inactivity) into two intervention arms:
Healthy Lifestyle Program (HeLP) included standard guideline-based physiotherapy, targeted lifestyle education, telephone-based health coaching, and personalized clinician consultations.
Guideline-only physiotherapy care comprised standardized patient education, exercise recommendations, and basic management advice.
Disability-related LBP was evaluated using the Roland Morris Disability Questionnaire (RMDQ) score (a 0–24 scale, with higher scores representing greater disability). At baseline, RMDQ averages were 14.7 for the HeLP intervention group and 14.0 for the standard care group. At 26 weeks, the HeLP group demonstrated statistically significant improvement, with an average –1.3-point difference in RMDQ scores (95% CI, a –0.2– to 2.5–point difference) compared to the control group.
Secondary outcomes
Participants receiving HeLP showed further advantages:
Weight reduction: Mean difference of 1.6 kg (95% CI, –0 to –3.2 kg).
Enhanced physical functioning score: improvement by 1.8 points (95% CI, 0.1–3.4).
However, the intervention did not significantly impact other secondary measures, including smoking cessation, pain intensity reduction, mental health quality indicators, or incidence of serious adverse events.
Chris Williams, MD, the study’s co-author and an associate professor at the University of Sydney, emphasized, “Clinicians treating back pain should consider how they integrate lifestyle support into their day-to-day care.”[]
A multimodal pain management model
Board-certified plastic surgeon Luis Vinas, MD, says, “I expect a move toward multimodal pain management strategies that lean less on opioids and more on targeted therapies.”
Dr. Vinas explains that integrating lifestyle modifications into novel and recently approved non-opioid analgesics like suzetrigine presents a promising strategy for enhancing pain management while mitigating the risks associated with opioid therapies.
Clinical trials have demonstrated that suzetrigine provides pain relief comparable to opioid combinations like hydrocodone-acetaminophen, with a reduced risk of addiction and milder side effects, including itching, muscle spasms, and rash.[]
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