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Randomized, Controlled, Crossover Study of Self-administered Jacobson Relaxation in Chronic, Nonspecific, Low-back Pain

Raquel Ajo, PhD; Olga Alda, PhD; Maria-del-Mar Inda, PhD; Cesar Margarit, PhD, MD; Margarita Mateu, MSS; Domingo Morales, PhD; Ana M Peiro, PhD, MD; Carlos J van-der Hofstadt, PhD

Context • Opioids decrease pain and improve functional capacity and quality of life; however, they are not always effective and are associated with harmful side effects. Few studies have shown that relaxation-based therapies, in comparison with usual care, can decrease pain. Objective • The objective of the study was to investigate whether a controlled relaxation treatment, Jacobson progressive muscular relaxation (PMR), was effective in relieving chronic low-back pain (CLBP) and reducing pain comorbidities. The research team hypothesized that PMR-controlled relaxation could be more effective in reducing CLBP than music. Design • The research team designed a randomized, controlled, crossover study. Setting • The study took place in the pain unit, a clinic, in the Department of Health at Alicante-General Hospital (Alicante, Spain). Participants • Participants in this study were 58 adults with nononcological CLBP, secondary to lumbar canal stenosis, who had been treated with opioids without any changes in the 3 mo prior to the study. Intervention • Participants were randomly assigned to 1 of 2 groups, each of which received 2 treatments, but in a different order (ie, either AB or BA where A was the standardized PMR, the intervention, and B was relaxing music, the control. For both groups, the 2 treatment periods were 8 wk in length, with a 1-mo washout period between them. Outcome Measures • The primary outcome measures included (1) a visual analogue scale—pain and relief intensity; (2) the 12-item short form health survey—quality of life; (3) the hospital anxiety and depression scale—anxiety and depression; and (4) the medical outcomes study sleep scale—sleep disturbances. Secondary outcome measures included a self-efficacy scale and a measure of satisfaction with treatment and compliance. Results • Pain was mostly mild to moderate. Greater decreases in pain between baseline and postintervention were observed for the PMR vs the control treatment in the mild pain category, with a VAS difference of 1.8 cm and P = .018. Significant differences were also found in anxiety, depression, quality of life, and sleep between participants in the 3 pain categories. Self-rated adherence was high. Conclusions • Findings support the efficacy and acceptability of a self-guided PMR intervention for reducing CLBP with minimal time with a therapist.

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