A combination of healthy lifestyle management and guideline-based care offered only slight enhancements in chronic low back pain when compared to guideline-based care alone, according to a study published in JAMA Network Open.

Low back pain is a global health concern, leading to considerable disability and impacting public health significantly. Studies have linked lifestyle risk factors such as being overweight, smoking, physical inactivity, and poor diet to the development and persistence of low back pain. Moreover, disability from back pain can reinforce unhealthy behaviors, further increasing the risk of chronic diseases.

The Scale of the Problem

The World Health Organization (WHO) has identified low back pain as the leading cause of disability worldwide, affecting 619 million individuals currently and projected to rise to 843 million by 2050. It is a condition that can impact people at any age, with most encountering back pain at some point in their lives.

Despite its prominence, the WHO does not recommend weight loss as a treatment for low back pain due to a lack of supporting evidence. Researchers identified this gap when examining the relationship between low back pain and a healthy lifestyle.

The HeLP Trial: Addressing Knowledge Gaps

To fill this knowledge gap, researchers developed the HeLP (Healthy Lifestyle Program) for Chronic Low Back Pain Trial. The study aimed to evaluate the benefits and potential risks of integrating healthy lifestyle management with guideline-based care in treating chronic low back pain compared to guideline-based care alone.

Study Design and Participants

The trial took place from September 8, 2017, to December 30, 2020. It focused on adults with nonspecific chronic low back pain who exhibited at least one lifestyle risk factor like being overweight, insufficient physical activity, poor diet, or smoking.

The HeLP intervention included guideline-based care, along with specific healthy lifestyle education and support provided during clinical consultations, access to educational resources, and telephone-based health coaching. Participants received up to four physiotherapy sessions and one dietitian session over 12 weeks, centered around pain education, lifestyle changes, and self-management plans.

In contrast, patients in the guideline-informed care group received standard back pain education, advice, and exercises, attending three consultations over 12 weeks. Clinicians did not provide additional lifestyle advice beyond exercise recommendations. Participants were randomly assigned to either the HeLP or the control group in a 1:1 ratio.

Results of the Study

A total of 344 individuals (mean age 50.2 years; 55% women) were included in the study, with 172 participants in each intervention group. After 26 weeks of follow-up, data was collected from 142 participants in the HeLP group and 147 in the guideline-based group.

The findings indicated that integrating healthy lifestyle management into care for low back pain resulted in modest improvements in disability at 26 weeks compared to guideline-based care alone. There were also minor reductions in weight and improvements in physical quality of life, although there was no significant difference in pain intensity, mental quality of life, or smoking rates.

Implications for Future Treatment

While the study showed minimal improvements, the results provide additional evidence supporting the role of lifestyle interventions in treating low back pain. As the WHO currently lacks sufficient evidence, lifestyle interventions are not recommended in its guidelines. However, future research similar to this trial could offer alternate methods for addressing low back pain and its associated lifestyle risks.

The study concludes that integrating lifestyle management into the care of patients with low back pain may provide a slight improvement in disability compared to guideline-based care alone, particularly for those who comply with at least half the treatment. This treatment model holds promise for reducing the disability burden of low back pain and offering opportunities to address prevalent chronic disease risks.

Conclusion

The HeLP trial highlights the potential of combining healthy lifestyle management with guideline-based care for chronic low back pain. Despite only showing minimal improvements, the study underscores the importance of lifestyle changes in pain management and provides a foundation for further research.

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