David Brill
Teaching the Alexander technique could be an effective and cost-efficient way to treat long-term chronic back pain, the results of a recent randomized controlled trial suggest.
Patients who received a series of 24 lessons scored significantly lower on a disability scale 1 year later and spent considerably fewer days in pain than those in the control group.
Six lessons in combination with an exercise prescription was slightly less beneficial but was the most cost-effective option for treating back pain in the primary care setting, the researchers reported.
The Alexander Technique is a method for improving posture, balance and co-ordination, with a particular focus on releasing tension in the spine, neck and head.
The trial included 579 chronic or recurrent back pain sufferers and took place at 64 general practices in the UK. It is the first study to look at long-term outcomes of the technique in back pain, according to the authors, who published the trial findings and economic evaluation in two separate British Medical Journal papers. [2008 337:a884; 2008 337:a2656]
Patients were randomized to normal care, 6 sessions of therapeutic massage, or 6 or 24 lessons of the Alexander technique. Half of each group also received an exercise prescription from their doctor and behavioral counseling from a practice nurse.
Those receiving 24 Alexander technique lessons alone scored, on average, 3.4 points lower on the Roland Morris disability score at 1-year follow-up compared to those in the control group. This group also reported experiencing back pain on just 3 days out of the preceding 4 weeks, whereas control subjects reported pain on a median of 21 days during this period. Adherence was high and there were no adverse events reported for either exercise or the Alexander technique.
Six lessons combined with exercise yielded 72 percent of the beneficial effects of 24 lessons alone but was the most economically viable combination, costing an additional £64 (US$ 94) per point on the disability scale, £43 (US$63) per pain-free day, and £5,332 (US$7,855) per quality-adjusted life year gain.
The massage intervention was beneficial at 3-month follow-up but had no significant effects after 1 year.
Back pain is a common cause of primary care consultations, with an annual prevalence thought to range from 15 to 45 percent. It is the second most common reason for a visit to the physician in the US and the number one cause of activity limitation in under-45s. [Lancet 1999 Aug 14;354(9178):581-5]
Patients who received a series of 24 lessons scored significantly lower on a disability scale 1 year later and spent considerably fewer days in pain than those in the control group.
Six lessons in combination with an exercise prescription was slightly less beneficial but was the most cost-effective option for treating back pain in the primary care setting, the researchers reported.
The Alexander Technique is a method for improving posture, balance and co-ordination, with a particular focus on releasing tension in the spine, neck and head.
The trial included 579 chronic or recurrent back pain sufferers and took place at 64 general practices in the UK. It is the first study to look at long-term outcomes of the technique in back pain, according to the authors, who published the trial findings and economic evaluation in two separate British Medical Journal papers. [2008 337:a884; 2008 337:a2656]
Patients were randomized to normal care, 6 sessions of therapeutic massage, or 6 or 24 lessons of the Alexander technique. Half of each group also received an exercise prescription from their doctor and behavioral counseling from a practice nurse.
Those receiving 24 Alexander technique lessons alone scored, on average, 3.4 points lower on the Roland Morris disability score at 1-year follow-up compared to those in the control group. This group also reported experiencing back pain on just 3 days out of the preceding 4 weeks, whereas control subjects reported pain on a median of 21 days during this period. Adherence was high and there were no adverse events reported for either exercise or the Alexander technique.
Six lessons combined with exercise yielded 72 percent of the beneficial effects of 24 lessons alone but was the most economically viable combination, costing an additional £64 (US$ 94) per point on the disability scale, £43 (US$63) per pain-free day, and £5,332 (US$7,855) per quality-adjusted life year gain.
The massage intervention was beneficial at 3-month follow-up but had no significant effects after 1 year.
Back pain is a common cause of primary care consultations, with an annual prevalence thought to range from 15 to 45 percent. It is the second most common reason for a visit to the physician in the US and the number one cause of activity limitation in under-45s. [Lancet 1999 Aug 14;354(9178):581-5]
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