A Prospective Interventional Study Comparing a Multimodal Intervention Incorporating Behavior, Exercise, Nutrition, Medication, and Posture With Exercise and Medication in Patients With Chronic Nonspecific Low Back Pain
5 affiliations
- 1Neurosurgery, Park Hospital, Panipat, IND
- 2Neurorehabilitation, Medanta - The Medicity, Gurgaon, IND
- 3Neurosurgery, Max Hospital, Gurgaon, IND
- 4Neurosurgery, Medanta - The Medicity, Gurgaon, IND
- 5Neurosurgery, All India Institute of Medical Sciences, Bhopal, IND
Abstract
Background and objectives
Chronic nonspecific low back pain (CNLBP) is a leading cause of disability, and its management remains a significant challenge. While non-pharmacological interventions like exercise are recommended, the optimal treatment strategy is unclear. This study compared the effectiveness of a comprehensive, five-modality holistic program (behavior therapy, exercise, nutrition optimization, drugs, and posture training) with a standard two-modality intervention (exercise and drugs) for patients with CNLBP.
Methods
This prospective interventional study included 123 patients with CNLBP. Participants were randomly allocated to either a two-modality intervention (Group 1; n = 60) or a five-modality holistic program (Group 2; n = 63). The primary outcome was the between-group difference in pain (Visual Analogue Scale, VAS) at the six-month follow-up. Secondary endpoints, including changes in anxiety scores and analysis by pain location, were treated as exploratory.
Results
After six months, both groups showed clinical improvement. However, the five-modality group (Group 2) demonstrated statistically significant and superior improvements in pain compared to the two-modality group (Group 1). The between-group difference in mean improvement for the VAS score (3.65 vs. 1.55) was statistically significant (p < 0.001). Subgroup analysis revealed that patients with higher baseline anxiety showed significantly greater improvement with the holistic approach.
Conclusions
Findings from the current study support the adoption of a holistic, multidisciplinary strategy for the management of CNLBP. The integration of behavior therapy, nutrition optimization, and posture training alongside conventional exercise and medication provides a superior, long-term therapeutic approach. A comprehensive, five-modality treatment program is significantly more effective than a standard two-modality intervention for improving pain in patients with chronic nonspecific spinal pain.
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BibTeX
@article{koshti2026prospective,
title = {{A Prospective Interventional Study Comparing a Multimodal Intervention Incorporating Behavior, Exercise, Nutrition, Medication, and Posture With Exercise and Medication in Patients With Chronic Nonspecific Low Back Pain}},
author = {Sameep H Koshti and Amit Soni and Himanshu Champaneri and Deepak K Bhangale and Amit Agrawal and Sudhir Dubey},
journal = {Cureus},
year = {2026},
month = oct,
doi = {10.7759/cureus.117483},
url = {https://doi.org/10.7759/cureus.117483},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - A Prospective Interventional Study Comparing a Multimodal Intervention Incorporating Behavior, Exercise, Nutrition, Medication, and Posture With Exercise and Medication in Patients With Chronic Nonspecific Low Back Pain
AU - Sameep H Koshti
AU - Amit Soni
AU - Himanshu Champaneri
AU - Deepak K Bhangale
AU - Amit Agrawal
AU - Sudhir Dubey
PY - 2026
DA - 2026/10/05
JO - Cureus
DO - 10.7759/cureus.117483
UR - https://doi.org/10.7759/cureus.117483
AB - Background and objectives Chronic nonspecific low back pain (CNLBP) is a leading cause of disability, and its management remains a significant challenge. While non-pharmacological interventions like exercise are recommended, the optimal treatment strategy is unclear. This study compared the effectiveness of a comprehensive, five-modality holistic program (behavior therapy, exercise, nutrition optimization, drugs, and posture training) with a standard two-modality intervention (exercise and drugs) for patients with CNLBP. Methods This prospective interventional study included 123 patients with CNLBP. Participants were randomly allocated to either a two-modality intervention (Group 1; n = 60) or a five-modality holistic program (Group 2; n = 63). The primary outcome was the between-group difference in pain (Visual Analogue Scale, VAS) at the six-month follow-up. Secondary endpoints, including changes in anxiety scores and analysis by pain location, were treated as exploratory. Results After six months, both groups showed clinical improvement. However, the five-modality group (Group 2) demonstrated statistically significant and superior improvements in pain compared to the two-modality group (Group 1). The between-group difference in mean improvement for the VAS score (3.65 vs. 1.55) was statistically significant (p < 0.001). Subgroup analysis revealed that patients with higher baseline anxiety showed significantly greater improvement with the holistic approach. Conclusions Findings from the current study support the adoption of a holistic, multidisciplinary strategy for the management of CNLBP. The integration of behavior therapy, nutrition optimization, and posture training alongside conventional exercise and medication provides a superior, long-term therapeutic approach. A comprehensive, five-modality treatment program is significantly more effective than a standard two-modality intervention for improving pain in patients with chronic nonspecific spinal pain.
SN - 2168-8184
ER -