Non-Invasive, Drug-Free Pain Treatment Offers Hope Amid US Opioid Crisis

Non-Invasive, Drug-Free Pain Treatment Offers Hope Amid US Opioid Crisis

Cleveland Clinic’s Back on TREK program uses a combination of behavioral and
physical therapy for lower back pain, with further potential applications


 Wednesday, August 14, 2019: Cleveland Clinic’s Back on TREK program, offering non-invasive, drug-free treatment for lower back pain, has seen very encouraging results and experts say it could play a significant part in resolving the United States’ growing opioid crisis.

The US Centers for Disease Control and Prevention (CDC) currently estimates that on average 130 Americans die every day from an opioid-related overdose, and around 40% of these deaths involve a prescription opioid.


Back on TREK (which stands for ‘Transform, Restore, Empower, Knowledge’) uses a combination of behavioral medicine for pain and physical therapy to treat patients who have had lower back pain for three months or more.


“The results have been very encouraging,” says Cleveland Clinic psychologist and director of the program, Dr. Sara Davin.


“I recently led a study that found reductions in disability and improvement in quality of life were remarkably greater in those who completed Back on TREK when compared to a similar group of patients who completed a course of traditional physical therapy.”


Back on TREK was introduced as a pilot program in 2016, and is now established at three Cleveland Clinic facilities, overseen by a multidisciplinary team of spine specialists, psychologists and physical therapists.


“Our therapy methods are not ones that patients have typically encountered before – our physical therapists use Pain Neuroscience Education, while our psychologists use cognitive behavioral therapy tailored for pain management,” explains Dr. Davin.


The role of the pain psychologist is to equip patients with tools to reduce their pain, improve their function, and reduce stress associated with pain.

“The program can also help individuals who are planning to, or have had, surgeries for pain. The great news is that the techniques taught in the program can help to improve surgical outcomes! Additionally the TREK program can,help those who would like to learn how to manage their pain without opioids, or with less medication overall,” says Dr. Davin.

The Back on TREK team reports that the majority of individuals who complete the program demonstrate clinically significant improvements in pain-related function, pain interference and quality-of-life indicators, as well as observing a reduction in fatigue, sleep and anxiety .

A less expected but often-reported bonus is improved social role satisfaction, which Dr. Davin and her colleagues believe results from two factors – the first being the emphasis they place on encouraging patients to re-engage in life, since pleasure has been shown to decrease physical pain.

The second factor is the strong group focus in the program, particularly as fellow participants share a bond over a common problem.

Two of the three weekly sessions are group or individual physical therapy sessions. Participants attend one 90 minute group psychology session a week, which involves cognitive and behavioral skill building as well as in-session meditation practice.


After four weeks, patients are reevaluated by the multidisciplinary TREK team and, based on their needs and results, could continue on the program for up to 10 weeks.


Dr. Davin says the behavioral techniques she teaches would work for any chronic pain condition, although the physical therapy would need to be specific to each condition, so there is a far wider application for this type of program.


“It is increasingly being accepted that programs such as this should be the standard of care for any chronic pain, but there are few available in the US,” says Dr. Davin.


She points out, however, that there are new efforts to scale TREK to abbreviated and/or digital formats to reach more patients. Additionally, she emphasizes that many of the cognitive and behavioral techniques (CBT) for pain used in the program could be taught to practitioners in other medical disciplines, thus broadening its reach.




About Cleveland Clinic

Cleveland Clinic is a nonprofit multispecialty academic medical center that integrates clinical and hospital care with research and education. Located in Cleveland, Ohio, it was founded in 1921 by four renowned physicians with a vision of providing outstanding patient care based upon the principles of cooperation, compassion and innovation. Cleveland Clinic has pioneered many medical breakthroughs, including coronary artery bypass surgery and the first face transplant in the United States. U.S. News & World Report consistently names Cleveland Clinic as one of the nation’s best hospitals in its annual “America’s Best Hospitals” survey. Among Cleveland Clinic’s 66,000 employees are more than 4,200 salaried physicians and researchers and 16,600 nurses, representing 140 medical specialties and subspecialties. Cleveland Clinic’s health system includes a 165-acre main campus near downtown Cleveland, 11 regional hospitals in northeast Ohio, more than 180 northern Ohio outpatient locations – including 18 full-service family health centers and three health and wellness centers – and locations in southeast Florida; Las Vegas, Nev.; Toronto, Canada; Abu Dhabi, UAE; and London, England. In 2018, there were 7.9 million total outpatient visits, 238,000 hospital admissions and observations, and 220,000 surgical cases throughout Cleveland Clinic’s health system. Patients came for treatment from every state and 185 countries. Visit us at Follow us at and News and resources available at



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