The Latest Evidence For Managing Low Back Pain With James McAuley, PhD

Welcome back to the Healing Pain Podcast with James McAuley, PhD

My expert guest is Dr. James McAuley. He is a Psychologist and Assistant Professor in the School of Medical Sciences, as well as a Senior Research Scientist at Neuroscience Research Australia, which is an independent not-for-profit institute based in Sydney, Australia. James is a leader in brain and nervous system research, including how to best treat many chronic pain syndromes. He has published over 170 scientific articles and lectures at international conferences on the best evidence for the treatment of persistent pain.

On this episode, you’ll learn about the latest advances for the treatment of chronic low back pain, where the research is heading, and we’ll bust some myths about common treatments that are currently utilized for low back pain. We’ll discuss if there’s evidence to support them in clinical practice. You might be surprised by what he’s discovered and what works for the treatment of chronic low back pain. I enjoyed this episode with James. We dived into the research around what works and what does not work for chronic low back pain. Make sure to share this episode with your friends and family and hop on over to iTunes, and give me a five-star review so we can share this important work with your friends and colleagues.

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The Latest Evidence For Managing Low Back Pain With James McAuley, PhD

James, welcome to the show. It’s great to have you here.

Thanks for having me on, Joe.

I read your bio to our tribes. Everyone has a good idea of who you are and what you do. You’re a psychologist who studies pain. A lot of it is within the realm of topics that interest both psychologist as well as physiotherapist and other practitioners who treat pain. Tell us where you work and what that looks like.

I’m an Associate Professor at the University of New South Wales in Sydney, Australia. It’s in the Department of Exercise Physiology, although I’m not an exercise physiologist, I’m a psychologist. I also got an appointment at a research institute, which is about a five-minute walk away from my department. That research institute is called NeuRA, which stands for Neuroscience Research Australia. That’s a research-intensive organization. There’s no teaching or anything that goes on there other than with graduate students or PhD students. That’s full of people who are doing research trying to figure out diseases of the brain and mind. That’s what my research is on pain.

NeuRA, encompasses aiming to study the mechanisms and treatment of pain, but they’re also looking at other aspects of the brain.

There’s a number of different groups. I’ve got a center there, The Center for Pain IMPACT. It stands for Investigating Mechanisms of Pain to Advance Clinical Translation. That’s where we are. There’s a group of us. Siobahn Schabrun might be somebody that you may have heard of. David Seminowicz is also there and so is Sylvia Gustin and myself. We have a group together.

You and your group personally are investigating the mechanisms of pain and how that translates to clinical applications for the treatment of pain for practitioners. I know you’ve done a number of randomized controlled trials. Tell us what some of those are like and what your background is. What do you know regarding chronic pain and some of the research?

I did my PhD in the UK and then after that, I moved to Australia to take up a postdoc at the University of Sydney. The postdoc was with a couple of researchers. Chris Maher, he’s Professor Chris now. He wasn’t at the time. I don’t even think he was an associate professor, and Kathy Refshauge. They were setting up a group and my job as a postdoc was to help them set up the group. We were interested in the contemporary management of low back pain, acute and chronic. We designed a series of randomized control trials to investigate different types of commonly used therapies, mostly within physiotherapy for the management of low back pain, acute and chronic. What was notable about those trials at the time was that in many of them, we used placebo control.

We were interested in what was the additional benefit over and above the benefits that you might get from a sham. That might be your expectations that treatment might work. It might be that you’re coming to a research institute or something like that. We were interested in what was the specific additional analgesic effect of treatments that are commonly available in physiotherapy. Some of those results surprised us at the time because we didn’t set out to disprove anything. We set out to find evidence and we were surprised that almost all of these commonly available treatments offered very little benefit if any over placebo, particularly for acute low back pain, which is an area that I’m interested in.

You did a whole study in JAMA Neurology, but tell us about some of the past RCTs that you’ve had, that were surprising for you and potentially other peers and colleagues in the field when you published your research. One of the reasons why I wanted to have you on is because some of your research might be surprising for people who are excited about certain treatment techniques. When they read your research, they might feel a little bit taken aback. Maybe, we should put it that way.

Taken aback, maybe. Possibly even disappointed. That’s the thing about research. It’s is a hard master or mistress. Nine times out of ten it proves you wrong. If you find any positive findings or anything that looks like it’s the signal in a randomized control trial, that’s a nice finding. One of the treatments we’re interested in is Manual Therapy. We tested Manual Therapy against the Placebo Manual Therapy or sham Manual Therapy, and that was detuned ultrasound. We found that wasn’t effective for acute low back pain. We had to look at non-steroidal anti-inflammatory. This is also in the same trial and found that they didn’t add any additional benefit over the placebo. Those were for acute low back pain. We’re also interested in exercise because at the time, the idea was that exercise probably wasn’t effective. There were some promising types of exercise like McKenzie Therapy or mechanical diagnosis and therapy. Everyone knows what is McKenzie Therapy. That was Luciana Machado’s trial. We tested that in addition to usual care from a GP that wasn’t against placebo.

In fact, one of the reasons that we didn’t test that against placebo is because we employed McKenzie manual therapists to provide the treatments. They were highly qualified McKenzie Therapists and fair enough they said, “This stuff works. It’s unethical for us to have a placebo control in the trial.” That’s what they said, but there was no effect of McKenzie Therapy for acute low back pain. There was no effect on pain intensity. That was a surprise to us certainly and the PhD student, Luciana Machado, on that trial. This trial has been nominated for one of the PEDro Top 20 Trials. Luciana came from Brazil to specifically study McKenzie Therapy because she thought this was going to work. This was to find evidence to support. I know that’s not the idea from where you start from in research, you start from the null hypothesis. Our expectation was this was a very promising type of exercise, yet not effective for acute low back pain.

Motor Control Therapy, we were interested in that as well. This is for chronic low back pain. We compared Motor Control Therapy exercises against placebo. This is detuned ultrasound and detuned shortwave. No effect for chronic low back pain. At the time, this seems quite revolutionary. These are treatments that were extremely common and being heavily promoted around the world. To a degree, they still are but at the time, they were seen as the saviors of allied health professions and for the treatment of back pain. We were surprised to find that they don’t offer any benefit in addition to standard placebo effects. That was a surprise for us.

Surprise for professionals and surprise potentially for patients. I’m wondering what the McKenzie Institute’s reply, rebuttal or thoughts were about your RCT? Because McKenzie has been around for a long time and there had been studies on McKenzie before.

The response was it works for chronic.

Your RCT specifically tested acute pain.

This was for acute low back pain. Those trials have never been done in chronic low back pain. Leo Costa did one in Brazil and found no effect as well. Leo’s wasn’t a trial against placebo though. These therapies, don’t add anything above placebo. I’m not a clinician. I find this stuff interesting and exciting for me because, what are we doing? Why do these therapies look like they’re working in clinical practice? Clinicians will swear blind that the patient got better. “I did this to the patient and the patient got better. They had chronic pain for years beforehand, stable chronic pain. I did the therapy and within two weeks, they were better.” That’s compelling evidence standing before you if you’re a therapist.

Why do the trials not show something if the evidence of your own eyes and your own experience is telling you something quite different? I find that an interesting question. What happens is there are all other things that go on and we know this stuff. I don’t want to patronize people. People know this stuff right now. They know that people usually come to see you if you’re a clinician. They usually come to see you when they’re feeling bad. Chances of them feeling a bit better in a couple of weeks are much higher than the chances of them feeling worse. On average, you tend to remember the patients that did well. We don’t remember the patients that did badly. They might not even come back.

Importantly to me, pain is far more complicated than just intervening at the periphery or intervening where someone says it’s sore, where they feel the pain is coming from. Particularly for chronic pain but also for acute, pain is much more complicated than that. That then drove the next phase of my research career when I was disappointed with these trials thinking, “What’s going on?” I moved to NeuRA to work with Lorimer Moseley, then that was the second half of my career.

In 2019, you published a study in JAMA Neurology, Journal of the American Medical Association Neurology. The study is called The Effect of Intensive Patient Education Versus Placebo Patient Education on Outcomes in Patients with Acute Low Back Pain. That was a randomized controlled trial. Tell us a little bit about the aim of that study.

HPP 171 | Managing Low Back Pain
Pain is far more complicated than just intervening at the periphery or intervening where someone says it’s sore.


The first thing to point out is that in our previous work, we couldn’t find any intervention and no one has found any intervention for acute low back pain. If you take a group of people with acute low back pain, you randomize them and you treat half of them with any intervention that you can come up with, compared to leaving them alone. No one has found an intervention yet that passes that test.

That’s important to clarify. What you’re saying based on high quality research like RCTs that are powerful studies. Whether it’s exercise, mindfulness, different types of psychotherapy, analgesics, manual therapy, dry needling, acupuncture, we go down the list. We all know there are many different types of interventions for pain. Specifically for acute low back pain, there’s no research to support that any of them work.

That’s correct. I feel extremely confident in saying that. Does that mean there aren’t promising ones? Probably not, but when they’re tested in trials, we haven’t found anything yet that works. We were interested in this group of people with back pain. We did this large cohort study and we found that most people recover from acute low back pain regardless of what happens. The recovery rates are quick and good. It doesn’t matter what you do, people will get better anyway. It doesn’t matter if you don’t do anything, people will generally get better.

When we ask people, about 60% had zero pain at three months and 40% had at least some pain at three months. The point about that is it’s difficult if you’re doing a randomized control trial with this big group. To find an effect, you need thousands and thousands of people, then you have to look for treatment effect modifiers, etc. It’s a complicated research problem. There’s another way around that and that is to try and identify the people who you think are going to do badly and then try intervening with them. The ones who you think is going to do well, leave them alone because they’ll get better anyway.

That’s a research question. It’s also a clinical question as well. How do you identify people who are going to do badly? We developed a prognostic model, which we turned into a clinical tool called PICKUP. Anyone can use that, clinicians or patients. We developed that tool to help us identify who was a high risk of doing poorly, doing badly. We’d only interview with those people. There are a few of these tools around. You’re probably familiar with the STarT Back tool. There are a couple of American ones. The problem about these tools is they actually work pretty well for people who are at low risk. You can identify the people that are going to do well. When you get to the higher risks, the tool says, “This person is at a high risk.” A lot of those people still get better anyway and some of them get worse. It doesn’t do so well at the high risk.

They’re still useful because you can screen out 50% of the people who are going to do well. You’re left with a heterogeneous group, but you can at least get rid of 50% from the trial who were going to do well. It’s important to step forward to think about that. We used this tool to identify this group who are going to do badly and the tool has five simple questions. It’s how intense is your pain in the last week? What’s your risk? Do you think that you’re going to have persistent pain? Do you have any leg pain? Have you been bothered by feelings of depression in the last week? Is your back pain compensable? Are you getting any support for that?

I want to get clear that none of those questions should be thought of as causing people to not recover. These are just predictive. There may as well be questions like what’s your shoe size or what’s your hair color? People like this who have these characteristics don’t do very well for some reason we don’t know why. You can identify the group. We did that with the group of people who score a high risk of developing chronic pain. We intervened with those people. What would you do to intervene with those people? A few years ago, what would you say would be a promising intervention?

Based on the research, I would say some type of patient education and encouragement for them to maintain an active lifestyle and to keep moving despite the pain.

It’s some psych type thing because the idea is that with yellow flags and stuff like that, there are people who are going to do badly. It’s to do with the way they’re thinking about their pain or their thinking about themselves much more than what’s going on in their back.

How they’re currently coping with their pain.

That’s why I went to work with Lorimer because he developed Explain Pain. That was certainly and still is a popular approach. It revolutionized the way we think about management of nonspecific pain conditions.

I was talking to a psychologist who says, “For the first three sessions, all he does with his patients are explain pain/pain neuroscience education.” That’s pretty revolutionary because a psychologist now developed and adopted a Cognitive Behavioral Therapy in pain neuroscience education. It’s interesting that they’re using that as the primary tool versus traditional CBT.

It’s thought-stopping, reframing or anything, although that does include a little bit of reframing. It’s psychoeducation. That’s what I would say that was.

I like that word, psychoeducation. I don’t think it’s used enough, but I like that word for clinicians to help understand like, “What I believe happening is psychoeducation.”

It’s a bit more than just education and it’s not the standard way we usually think of psychology. I’ve always felt quite strongly about this. If your mom went to see a physio or a chiro, she would know straight away whether or not that physio or that chiro was any good. That probably has little to do with their technical skills. That’s far more about how they communicate, how they talk, this confidence that they exude, the patient feels safe with them, but possibly also empowered by them as well. These are all issues that we know straight away that’s a good clinician. Those things are psychological things that can be taught to clinicians, and they’re generally not. The program is so packed. Instead, you learn about how to turn on a machine.

We learn a lot of things, James.

I can say this as a psychologist.

Something we don’t need to learn at this point but we learn a whole lot of stuff.

It would be great to formally learn that stuff because that can be taught. Explain Pain is fascinating because, what is it? We’ve called it psychoeducation, but what’s it intending to do? Telling people about how pain is produced, what do we think that’s doing to somebody? They have more knowledge, but so what? They could learn about how a fridge works. They’ve got more knowledge, but what does that do to a person? How does that change anything within that person? What’s it targeting? For me, it’s reassurance. It is a well-thought out and highly-targeted reassurance. Reassurance in the dictionary means removal of fears and worries. That’s what this is. That’s what pain education, neuroscience education, Explain Pain or whatever group has developed is.

You’re the first person who’s ever mentioned reassurance with regard to pain neuroscience education, which is interesting, because when you read the literature on it, it’s all about decreasing fear, fear avoidance behaviors, the reconceptualization of certain concepts. There’s even some cognitive reframing that happens, pain beliefs, challenging beliefs, new thoughts about pain, even pain anxiety, different aspects of mood. You’re saying it’s purely reassurance. I want to toss one other thing in there and you let me know where this would land. Through that reconceptualization process, there’s a little bit of acceptance that happens. Was it accepted somewhere rolled into that reassurance?

HPP 171 | Managing Low Back Pain
Most people recover from acute low back pain regardless of what happens. It doesn’t matter what you do, people will get better anyway.


That’s possible. This is the difference between pain neuroscience education for chronic pain versus acute pain. You might want to spend a little bit more time on acceptance-based stuff for chronic, but less focused on that for acute pain. For acute pain and for me anyway, everything else that you said or the concepts that you touched was fears and worries, essentially. It might be slightly different words like catastrophizing and avoidance, but it’s fears and worries. It’s on all the guidelines for acute low back pain. Every single one says, “You should reassure patients that they have a good prognosis and that there’s nothing serious causing their pain.”

That sounds to me like Explain Pain or pain neuroscience education. It’s just done cleverly. It’s done over a long time. Your psychologist friend said three sessions and yet that wouldn’t be unusual. In the original papers, it was an hour-and-a-half over two sessions. We did it in the end about 45 minutes. One session and 45 minutes, and another session. It’s a week apart where we could get the patient back in and talk to them about what happened in the last week, etc. This is all intended to change the way we think about our pain to make us less fearful and less anxious about our pain and to make it less provoking of negative emotions and normalize it in a way. That’s reassurance.

I quite like that idea because the reassurance literature is quite interesting. The reassurance literature on pain, Tamar Pincus’ work, her theories are if you educate someone about their pain, that gives them the skills for dealing with an exacerbation at some point in the future, which they may have. Her argument is that there are two types of reassurance. Those emotional reassurance and that’s what I do to my three-year-old. It’s one of my favorite things with my three-year-old. I can kiss his pain away. It’s fantastic. He falls over and he has a sore knee and he comes crying. I literally give it one kiss. I say, “There, it’s better,” and runs off again. That’s fully emotional reassurance. Cognitive reassurance would be for me to sit down and tell him about pain pathways.

Tamar Pincus’ idea is that there are two types of reassurance: emotional and cognitive. Maybe as clinicians, we should be a bit careful about providing the emotional reassurance which is the relationship that you give to a patient. It’s strongly developing this relationship so they feel reassured by you. All their anxiety and fears are reduced by being with you. You say, “Try not to worry,” that kind of reassurance. Her idea is that if you concentrate on that too much, then the patient feels a bit better. It’s not necessary for them to listen to the cognitive stuff because they feel better and their pain is gone. They don’t even listen to the cognitive stuff.

That’s an interesting perspective. I’m not sure how that sits with me as a clinician because I believe that as humans, we look for and seek nurturing and support. We’ve had it from the time we were babies and hopefully that was provided to you. For those who it wasn’t provided to, you see those people have problems coping later on in life. However, I’m wondering if that is the entrance ramp where you can get into the more cognitive reassurance once people feel like they are comfortable with you then.

For me, it’s an interesting discussion point because there’s little research in this area. I think that’s what Explain Pain does. It provides cognitive reassurance. We thought that was a promising intervention in this for people with acute low back pain. We randomized a couple of hundred people to either receive that or receive what we call placebo or sham, depending on your view. That was sitting with the clinician and the clinician, not giving you any advice or any education. It was control for time with the therapist. I chose that intervention because I was fully on board and I believe reassurances is powerful. This will be my biases and I believe psychology is important for people with acute low back pain.

I said researches are hard masters or mistress. It certainly is because we didn’t find any effect at all on pain. It made no difference at all on pain intensity even though we spent two hours providing the patient with this intensive pain education. We found that we were able to change their pain knowledge. We also found that we were able to reduce their catastrophizing and we were able to reassure them. That pain education did all those things, but no difference on pain or disability. That’s a challenge to me. This isn’t a group who you think need this. That to me is a challenge because where do we go from there?

How many people were in that RCT?

There were 202. There were 101 randomized to receive pain education and 101 to receive the sham education.

The sham education was sitting down with a practitioner and the patient were in essence telling their story.

They could talk about whatever they wanted to talk about. We recorded those sessions and we’ve been doing some qualitative work with them. There are some fascinating stuff in there about what patients think about their pain and what they’ve been told about. Some don’t even talk about their pain at all. They talk about the weather. The physios were trained using those basic communication skills to rephrase something that someone said and to keep the conversation going. It’s a challenge for physios to do that. This is the second trial that we’ve used this type of intervention. You’ll want to give some advice. You’ll want to correct some faulty beliefs. They hate doing that more than anything.

For the sham group or the placebo group, did you measure outcomes in that group? There are some studies that show that just talking to a licensed practitioner is in some ways comforting. That does help people cope.

We would have needed three groups in order to determine that. We would have needed pain education, the sham and nothing. People would have had to be randomized to those three groups. We didn’t have that third group. It’s true that we can’t tell whether or not the sham was active and that people felt better from that. What we can say is that giving patients two hours of pain education is no better than just a chat. Maybe the chat is effective. We don’t know, but certainly two hours of pain education is no better than a chat for acute low back pain.

Have you duplicated this study?

Not yet. It’s just been published.

Is it on your radar to duplicate it?

What we’ve done is we’re looking at this now in chronic low back pain as well. We’ve got a trial for chronic low back pain. That’s a very different type of treatment, but it’s just hardcore reassurance for chronic. The trial is called Resolve. That’s 276 people randomized to two groups. One group receives sham. They come in to NeuRA and they get this whole series of different sham techniques. I can’t talk about them because we’re unfinished with the data collection yet. It’s a graded sham. The other group gets this new treatment, which is developed from Lorimer’s Graded Motor Imagery, those concepts, the CRPS.

Ben Wong took this and turned it into something for back pain, which is interesting. This is chronic low back pain. There’s some type of tactile acuity dysfunction on your back. If I touch you on your back and you’ve got chronic back pain, most people don’t know if I’m touching them with a sharp or blunt object. They don’t know where I’m touching them. The tactile location is disrupted. If you draw on someone’s back words and shapes, they have difficulty understanding what those are. That’s graphesthesia problem. The nice thing is the more you do that, you can make that better. In some pilot work, it was showing that pain intensity reduces a little bit as well.

We also found that NOI Group, David Butler’s group, produced those laterality test. They do that for most body parts including the back. If you get people that are bad at that to watch, they can be trained. This is the second part of the grades. They’ve got tactile stuff moving into some motor stuff. You get people with back pain to watch videos of other people doing provocative movements. They don’t like it at all. In fact, it doesn’t produce pain sensations, but they don’t like it. They feel very uncomfortable, but then psychological principles, the more you watch it, the less threatening it becomes. We then take them out and get to show them, “Let’s see how you’re moving.” The physios can train that as well.

You’re moving into exposure and a Behavioral Operating Therapy in that case.

HPP 171 | Managing Low Back Pain
If you educate someone about their pain, that gives them the skills for dealing with an exacerbation at some point in the future.


That, and with goal setting as well, to take them out into the community. This is to get your brain ready. Pain education, tactile acuity training or sensory training, moving into motor training, and then out into real life. This is a twelve-week program. We finished recruitment and our final primary outcome has been collected. We will be analyzing that data. This is intensive reassurance for a patient with back pain. When I talked to the clinicians in the trials, I said, “What’s happening?” People understand that they should exercise and they should be active, but they don’t want to be because they still don’t feel safe. Fair enough, it’s going to hurt or if it doesn’t get any better, they still don’t feel safe. This treatment is intended to try and intervene at that level for these patients to make them feel very safe. When I say to make them feel safe, the actual intention is to make their brains feel safe. It’s less about, “Do you feel safe?” It’s more about, “How’s your brain processing the information that’s coming from the periphery?” That’s certainly the treatment rationale that we have. We’re waiting to hear to find out.

Please come back and share that information with us. I’ll be curious to learn what you discovered in that trial. I want to go back to the other trial about the acute low back pain first. As good clinicians should do, they should read the research and then apply it to practice. Ideally, that takes less than seventeen years, which is what the average is. From your results, should a practitioner or maybe someone who’s running group pain treatment in a hospital say, “I read this RCT and they found that for acute low back pain, pain education doesn’t work, so we shouldn’t do that.”

For acute, yes. For chronic, forget about this trial. It tells you nothing about chronic. For acute low back pain, if you spend three hours or you spend some time educating a patient about pain pathways and how the brain produces pain, I would say that’s not going to produce effects on pain disability. Patients aren’t going to recover any quicker. It will make them feel better. If someone comes in and they’re highly distressed and they’re worried about their back, then you can reassure them. You can remove their fears and worries. You can reduce their catastrophizing by doing this, but it won’t change their pain and disability. Hidden within that is something quite interesting. Catastrophizing is not a good target if you want to reduce pain and disability. You can reduce catastrophizing but that does not change their pain and disability. There’s a big literature around catastrophizing. It’s almost like it’s one of these psychological gods.

It’s the Holy Grail.

Changing catastrophizing does not change pain and disability. We’re doing a systematic review on that and I would say that this is something that we should move on from.

Beth Darnall might disagree with you.

She wouldn’t because I’ve seen her presenting this stuff. She can say that but if you look at her data, they’re tiny effects. She couldn’t find people with high catastrophizing in her studies. Her data will support some side of this. Psychologists are coming around to this. It’s a difficult one to let go off because it’s so ingrained that catastrophizing, worry, fear and panic about the future affects our pain intensity. It doesn’t.

I’ve heard both. There are still people who cling on to the pain catastrophizing and there are other professionals who started to let it go a little bit and realize that, “It’s there and maybe it should be scooped up with all the other things we’re working on, but it’s not a primary target.”

I’ll let that stand clinically but for research purposes, no. I can understand. One of the things I should say about my research and any research is that it informs clinical practice. It doesn’t direct clinical practice. A clinician’s practice is to take the research that you’ve got and you combine that with patient preferences and your experience to decide what to do with that patient in front of you. No research tells you what to do with that patient in front of you. Not one single piece of research can tell you that. Maybe if someone is highly catastrophizing and they’re sitting with you, you might have some ideas about how to do that. In terms of the research evidence, the catastrophizing is turning out to be something like fear avoidance. It’s a current fear avoidance. That’s what my research tells me.

They’re good models, which help clinicians and maybe even patients understand what’s happening to a certain extent, but necessarily targeting them in practice may or may not be what you want to do, based on the research.

My advice to a clinician would be to focus on stuff that we know does change pain and disability and that is increasing someone’s confidence that they can perform activities. That’s well-spelled out in Bandura’s work on self-efficacy. That to me is where I would spend my efforts. That’s what the research tells me from my own work. We also looked at this within my trial and some other trials. That to me is where effort should be spent. Give the patients the confidence that they can do this themselves. That they don’t need a clinician, that they can do this stuff themselves. That will change their pain and disability. We’ve looked at that in causal mediation models, whereas catastrophizing and fear avoidance doesn’t.

That’s an excellent point. As a professional, what you want to try to do is put yourself out of business, which means that you’re giving the patient enough tools, confidence and reassurance that they can now move on in life. There may or may not be some pain and they should be fine.

That’s the clinician that I would send my mother to see.

It’s interesting though because it’s almost a little bit against the tide of being a clinician. You want to help. You’re such an empath. You want to get in there, develop that relationship and that bond. You want to educate and place your hands on people at times, and do all these things that you learned in school. It’s interesting how they may not be where we need to go.

I was talking to Michele Sterling about this at a conference and she said, “As clinicians, we systematically remove self-efficacy from patients.” That’s a good point. That’s in the training. It’s like, “Let me take care of you.”

Potentially, we have our own avoidance patterns where it’s difficult for us to sit there and see someone struggle and suffer a little bit, knowing that they may leave your office that day in more pain but no less pain than when they came in.

The question is, “Can we somehow show them that they have the skills to be able to control their symptoms?”

I believe we can because I’ve had people, just by listening to these podcast episodes, they email me and say, “Just by listening to you talk about information in pain,” in a way that is Explain Pain. In another way, what you’re saying is correct. They’re empowering themselves with the knowledge, that reassurance and they’re not necessarily seeing a practitioner. They’re downloading podcasts and listening to them week after week. I would imagine, it would be a great study to do, at probably 10, 20, 30, 40, 50 or 100 podcasts, they’ll feel reassured enough where, “This is what it is and I can move forward with life.”

That’s the critical part about treatment for me. There’s a certain person who goes to see a therapist, but it’s not everybody with pain. That might not have something to do with their pain intensity or disability, although those two things are important. The future for me in the research that I’m looking at is public education. This is where the biggest impact can be made. We know from Australian studies in the late 1990s, where those big public education campaigns can reduce pain intensity. Why are we not doing that? One of the reasons we don’t do that is because it’s expensive to do because it cost about $20 million at the time. Now it would be about $100 million. No one’s got that money. We’re developing some social media campaigns with an advertising agency.

What we’ve thought is, what patients need to know is there’s nothing seriously wrong with their back, and you don’t even need to know any of that in order for you to get on with the rest of your life. We can’t sell out that message. We’ve been trying for years to sell out to patients and we can’t seem to do it. We’ve gone to see a big international advertising agency and said, “How do you do this?” We’ll be shooting and I hope it’s not embarrassing some of the stuff with advertising. You have to jump. Anyway, we’ll have a new social media campaign out.

HPP 171 | Managing Low Back Pain
Explain Pain

Please share that. I’d love to see what it’s about. I’ll share it with my tribe of followers. In many ways, when you say why are we not doing that? I think we’re doing it right here now, you and I, in one way or another. We love for this to hit billions of people, which is easier when a government gives you lots of money to move the campaign forward. Each of us, if we contribute our own way, it does make a difference. Please come back and share that information with us. Share any of the new randomized clinical trials that you have on acute or chronic pain, even if they are not as exciting as we’d like them to be with the interventions we’re doing. They still shed some light. James, please tell everyone how they can learn more information about you and all the great things that you’re doing.

I love talking about this stuff and it’s interesting for me. Thank you. You can google me, search for James H. McAuley. If you put James McAuley, there’s a now dead Australian poet that comes up, he’ll come to the top of your list, a right-wing poet. That’s not me. I’m James H. McAuley and then you can see all my stuff there. That will come up. We also have that clinical prediction model that can be used by clinicians or patients.

You can find that at the and also include that as a free giveaway. You can download that. I want to thank James for being with us. Make sure you check him out. You can find him at NeuRA online. You can read his studies, get some great randomized clinical trials that, especially if you’re a clinician, will interest you and pique your interest around what you’re doing, whether it’s effective or not. Make sure to share this episode with your friends and family on Facebook, Twitter, LinkedIn, wherever your socials are, wherever there are practitioners and people with pain looking for the latest and recommended outcomes and treatments. Stay good and we’ll see you.

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About Dr. James McAuley, PhD

HPP 171 | Managing Low Back Pain

Dr. James McAuley is a psychologist, A/Prof in the School of Medical Sciences & Senior Research Scientist at NeuRA.

James completed his Ph.D. at Brunel University, London (2003). He took up a post-doc at the University of Sydney in 2004 and then at the George Institute for Global Health. In 2010 he moved to NeuRA where he set up the Centre for Pain IMPACT (investigating mechanisms of pain to advance clinical translation). In 2017 James was appointed as A/Prof to the Exercise Physiology department at UNSW.

James has published >170 articles, his H-index is 53 and he is ranked (Scopus) the third most productive researcher in his field. He holds over >$10M in research funding and in the last 5 years has given invited presentations at 12 international and 15 national conferences and scientific meetings. James has supervised 18 PhD students and mentored 4 postdocs. James is the chair of the back pain group of SPHERE MSK and is a member of the Scientific Advisory Group for the Australian and New Zealand Musculoskeletal Clinical Trials Network (ANZMUSC). In 2015 James founded the NSW network for pain PhD students/ECRs (SPRiNG).

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