Comparisons of the effects of psychologically-informed and usual physiotherapy on pain sensitivity in chronic low back pain: an exploratory randomized controlled trial

Hugo Massé-Alarie; Amélie Desgagnés; Claudia Côté-Picard; Olivier Liberty; Pierre Langevin; Mathieu Piché; Yannick Tousignant-Laflamme

doi:10.33393/aop.2025.3323

Authors

Hugo Massé-Alarie Cirris, School of Rehabilitation Sciences, Université Laval, Quebec City - Canada https://orcid.org/0000-0003-4472-9656
Amélie Desgagnés Cirris, School of Rehabilitation Sciences, Université Laval, Quebec City - Canada https://orcid.org/0000-0002-6291-4866
Claudia Côté-Picard Cirris, School of Rehabilitation Sciences, Université Laval, Quebec City - Canada https://orcid.org/0000-0002-1800-1832
Olivier Liberty Cirris, School of Rehabilitation Sciences, Université Laval, Quebec City - Canada https://orcid.org/0009-0009-4326-4165
Pierre Langevin Cirris, School of Rehabilitation Sciences, Université Laval, Quebec City - Canada https://orcid.org/0000-0003-4339-3687
Mathieu Piché Chaire de Recherche Internationale en Santé Neuromusculosquelettique, Université du Québec à Trois-Rivières, Trois-Rivières - Canada https://orcid.org/0000-0003-4171-2226
Yannick Tousignant-Laflamme Centre de recherche du CHUS, Université de Sherbrooke, Sherbrooke - Canada https://orcid.org/0000-0002-1133-8707

DOI:

https://doi.org/10.33393/aop.2025.3323

Keywords:

Exercise-induced hypoalgesia, Pressure pain threshold, Psychologically informed physiotherapy, Quantitative sensory testing, Temporal summation of pain, Usual physiotherapy

Abstract

Introduction: The presence of altered central pain processing and modulation, as well as negative psychological factors, have been suggested to impede recovery in chronic low back pain (CLBP). Psychologically-informed physiotherapy (PiP) aims to specifically address the latter factors—in addition to physical factors—to improve treatment effects. This study aims to determine if the effect of PiP is superior to usual physiotherapy (UP) on pain sensitivity and modulation in participants with CLBP and if changes in these variables were associated with changes in clinical outcomes.

Methods: Forty participants with CLBP were randomly allocated to PiP or UP. Seven physiotherapy sessions over 6 weeks plus a booster session at an 11-week follow-up were delivered. Pressure pain threshold (PPT), temporal summation of pain (TSP), and exercise-induced hypoalgesia were assessed on lumbar, upper, and lower limb sites at baseline and after 6 weeks. Linear mixed models tested if PiP was superior to UP on pain sensitivity/modulation. Linear regressions tested if pain sensitivity/modulation changes were associated with changes in clinical outcomes (pain intensity, physical functioning, symptoms of central sensitization).

Results: PiP was not superior to UP to modulate pain sensitivity/modulation variables. All PPTs increased after 6 weeks regardless of the approach. Lumbar PPT and lumbar and lower limb TSP changes were associated with physical functioning changes.

Conclusion: Although our study suggests that neither approach has a superiority to impact on pain sensitivity, both approaches elicited widespread hypoalgesia. Future powered trials should verify if pain sensitivity can be a mediator of physical functioning improvement, as suggested by our results.

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