Enhanced Therapeutic Alliance Modulates Pain Intensity and Muscle Pain Sensitivity in Patients With Chronic Low Back Pain

Physical therapy influences chronic pain by means of specific ingredients of an intervention as well as nonspecific contextual factors such as the setting and therapeutic alliance (TA) between provider and patient.  This experimental controlled study compared the effect of enhanced versus limited TA on pain intensity and muscle pain sensitivity in patients with chronic LBP receiving either active or sham IFC.  Participants (117 participants with chronic low back pain (LBP)) were randomly divided into 4 groups: active limited (AL) (n=30) included the application of active IFC combined with a limited TA, sham limited (SL) (n=29); sham IFC combined with a limited TA, active enhanced (AE) (n=29); active IFC combined with an enhanced TA, and sham enhanced (SE) (n=29); sham IFC combined with an enhanced TA.

The results showed that the context in which physical therapy interventions are offered has the potential to dramatically improve therapeutic effects. The combination of enhanced TA active IFC appears to lead to clinically meaningful improvements in outcomes when treating patients with chronic LBP.