Graded Sensorimotor Retraining Modestly Improves Chronic Back Pain

Graded sensorimotor retraining significantly improved pain intensity at 18 weeks with a low rate of adverse events in patients with chronic low back pain.

Among patients with moderate to severe chronic low back pain, the use of sensorimotor retraining, compared with a sham procedure and attention control, was shown to significantly improve pain intensity at 18 weeks. These are the findings of a study published in JAMA.

Researchers conducted a parallel, 2-group, randomized clinical trial and recruited participants from Sydney, Australia, with chronic (ie, more than 3 months) nonspecific back pain from primary care and community settings. The researchers sought to estimate the effect of RESOLVE — a graded sensorimotor retraining intervention — on level of pain intensity among individuals with chronic back pain.

A total of 276 adults randomly assigned in a 1:1 ratio to the intervention group or the matched attention control sham procedure group. All participants were informed that both interventions contained treatments designed to target central nervous system function, combined with treatments directed toward functioning of the back. They were also told that some of the treatments were not “active.” The graded sensorimotor retraining intervention was delivered by clinicians at a medical research institute in Sydney.

The first study participant randomly assigned on December 10, 2015, and the last patient was randomly assigned on July 25, 2019. Follow-up of all participants was completed on February 3, 2020. The primary study outcome was pain intensity at 18 weeks, which was evaluated on an 11-point numerical rating scale, with 0 representing “no pain” and 11 representing the “worse pain imaginable” (between-group minimum clinically important difference (MCID], 1.0 points; within-group MCID, 30% change from baseline).

The improvements in pain intensity were small, and further research is needed to understand the generalizability of the findings.

The 138 individuals in the intervention group were asked to participate in 12 weekly clinical sessions and home training, which were designed to educate them about and assist them with movement and physical activity while experiencing lower back pain. Those in the control group were asked to participate in 12 weekly clinical sessions and home training as well, which required similar time as the intervention arm, but was not focused on education, physical activity, and movement. Individuals in the control group received sham laser and shortwave diathermy, which was applied to the back, and sham noninvasive brain stimulation.

The mean participant age was 46±14.3 years. Overall, 138 of the patients were women; 95% (261 of 276) of the participants completed the 18-week follow-up.

The researchers found that in the intervention arm, the mean pain intensity was 5.6 at baseline and 3.1at 18 weeks, compared with 5.8 at baseline and 4.0 at 18 weeks in the control group (estimated between-group difference at 18 weeks, –1.0 points; 95% CI, –1.5 to –0.4; P =.001), which significantly favored the intervention arm.

Study limitations warrant mention. These include the treating clinicians not masked to group randomization. Further, insufficient resources were available to collect data at 26-week and 52-week follow-ups in all of the participants. Additionally, all of the outcome measures were self-reported.

The researchers concluded that “The improvements in pain intensity were small, and further research is needed to understand the generalizability of the findings.”

Disclosure: Some of the study authors have declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of authors’ disclosures. 


Bagg MK, Wand BM, Cashin AG, et al. Effect of graded sensorimotor retraining on pain intensity in patients with chronic low back pain: a randomized clinical trial. JAMA. 2022;328(5):430-439. doi:10.1001/jama.2022.9930