Non-pharmacological Treatment for Chronic Back Pain

Non-pharmacological Treatment for Chronic Back Pain: a Randomised, Controlled Trial

The working hypothesis is that spa therapy in addition to usual care including home exercises (UCHE) will result in greater improvements in pain reduction, associated disability and quality of life for chronic low back pain patients. It follows that health resource consumption and linked costs should also be reduced. The primary objective of this study is therefore to compare the therapeutic effect of UCHE alone versus spa therapy in addition to UCHE for chronic low back pain.

Secondarily, the study will also (i) evaluate the therapeutic effects specific to each spa-centre, (ii) specifically describe effects among subjects who are currently engaged in a professional activity, (iii) evaluate treatment tolerance as well as (iv) per-patient health resource use and associated costs.

Inclusion Criteria:

• Adult patient presenting with chronic low back pain: usual pain of the lumbar region lasting for more than 3 months. This pain may radiate to the buttocks, iliac crest, and does not go past the knee.
• Patient presenting with a current pain intensity on a visual analogue scale (VAS) > or = 40 mm.
• The patient has signed the informed consent
• The patient is a beneficiary of a social security programme [national health insurance]

Exclusion Criteria:

• Patients with secondary low back pain
• Patients with severe depression, psychosis
• Patients who have already had a spa treatment in the previous 6 months
• Patients with a contraindication for spa treatment
• Patients with a professional activity related to hydrotherapy (to avoid any conflict of interest)
• Patients with sciatic pain beyond the knee (sciatica being a non-indication for spa treatment)
• Other treatments that may interact according to the judgment of the investigator
• Patients who live more than 30 km away from the spa