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The Somatic Connection  |   July 2016
Educational Interventions May Help Prevent Low Back Pain but Are Not Effective in the Prevention and Treatment of Nonspecific Neck Pain
Author Notes
  • Western University of Health Sciences College of Osteopathic Medicine of the Pacific, Pomona, California 
Article Information
The Somatic Connection   |   July 2016
Educational Interventions May Help Prevent Low Back Pain but Are Not Effective in the Prevention and Treatment of Nonspecific Neck Pain
The Journal of the American Osteopathic Association, July 2016, Vol. 116, 487-488. doi:10.7556/jaoa.2016.096
The Journal of the American Osteopathic Association, July 2016, Vol. 116, 487-488. doi:10.7556/jaoa.2016.096
Ainpradub K, Sitthipornvorakul E, Janwantanakul P, van der Beek AJ. Effect of education on non-specific neck and low back pain: a meta-analysis of randomized controlled trials. Man Ther. 2016;22:31-41. doi:10.1016/j.math.2015.10.012 
In our experience, manual medicine practitioners often include educational interventions about the musculoskeletal system when treating patients with nonspecific neck and low back pain. However, the effectiveness of this added educational intervention is controversial. Researchers in Thailand and The Netherlands conducted a meta-analysis of randomized controlled trials (RCTs) to assess the effectiveness of educational interventions on the prevention and cure of nonspecific neck and low back pain. 
Inclusion criteria for the meta-analysis were RCTs published in English between 1982 and March 2015 that compared educational intervention with noneducational intervention for patients with nonspecific neck and low back pain. Of the 4024 citations yielded from a search of several online databases, only 15 RCTs met the minimum criteria for having high-quality methods (as defined by 50% or greater on the PEDro [Physiotherapy Evidence Database] scale). The quality of evidence and strength of recommendations of these RCTs were evaluated using the GRADE (Grades of Recommendation, Assessment, Development, and Evaluation) approach. There were no criteria regarding the educational content, teaching method, follow-up duration, or disease stage. 
Six studies found education to be more effective and 9 studies showed no difference between interventions. The educational content included in these 15 RCTs was classified into 13 main topics, with anatomy (85%), exercise (64%), and pathophysiology (64%) occurring most frequently. The studies were further categorized into groups according to educational purpose, body region, outcome measurement, and duration of follow-up. In the 6 positive outcome studies, the educational content most emphasized were “function of the spine (40%), information on activity (23%), and information on coping with the problems (15%).” 
Although 3 studies demonstrated a positive effect of education on decreasing the incidence of low back pain, no study demonstrated more effectiveness of education on neck or low back pain intensity, disability level, or fear avoidance belief scores. Additionally, education did not show more effectiveness on neck pain prevention or low back pain prevalence, quality of life score, or work absence. Although this meta-analysis is limited by heterogeneity between studies in terms of the content of education, teaching method, duration of follow-up, and stage of disease, the authors concluded that educational interventions may help prevent low back pain but are not effective in the prevention and management of nonspecific neck pain. 
Considering that osteopathic manipulation has been proven to be an effective treatment for patients with low back pain, further high-quality RCTs focusing on the 3 most-emphasized educational topics in the positive studies, in addition to osteopathic manipulation, would be an interesting follow-up study to elucidate the role of patient education in the management of low back pain.