Clinicians may be able to help patients with chronic back pain overcome discomfort by employing a self-care program known as the Alexander technique, which is designed to help patients develop good musculoskeletal habits (e.g., proper posture and improved neuromuscular coordination).

A team of researchers led by Paul Little, MD, of the University of Southampton, England, assigned 579 primary-care patients with chronic or recurrent low back pain to one of four approaches: normal care (anything the clinician would regularly do for back pain, e.g., prescribe analgesics, give advice, refer to a specialist); six sessions of therapeutic massage; six lessons on the Alexander technique; or 24 Alexander lessons.

At the three-month and one-year marks, normal care had little impact on patient disability (as measured by the Roland-Morris score) or number of days in pain. Compared with the normal-care (control) regimen, massage resulted in 33% fewer days in pain, but the improvement in disability scores seen at three months was no longer evident after a year. 

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Conversely, the 24 Alexander lessons yielded an even greater benefit at one year than at three months, ultimately resulting in Alexander-24 patients having 42% less disability and 86% fewer days in pain than the control group. Even just six Alexander lessons led to 17% less disability and 48% fewer days in pain than the normal care at both three months and one year (BMJ. 2008;337:a884).