MMR: A Leading-Edge Approach to Chronic Low Back Pain

In chronic pain, psychological and social factors play a major role in addition to the physical causes of the pain. Chronic pain is caused by a complex interplay of biopsychosocial factors.

5 min read
Three panels each with a person representing exercise, relaxation, & knowledge.

Many people with chronic low back pain go through a long journey to find relief. (“Chronic” means lasting longer than 3 months.) They might try all kinds of options, like massage therapy, muscle relaxants, over-the-counter pain medications, and many more. Sound familiar?

According to the American College of Physicians (ACP), the above treatments can be helpful for acute low back pain. (“Acute” means lasting less than 3 months.) Unfortunately, though, the ACP doesn’t recommend these treatments as the first line of defense against chronic low back pain.[1] How come? Well, treating chronic low back pain at the physical level only is an incomplete strategy. That’s because chronic low back pain isn’t just caused by physical factors, like accidents, heavy lifting, or overstretching. In fact, it’s usually caused by a combination of physical, psychological, and social factors (known together as “biopsychosocial factors”).

The 3 Biopsychosocial Factors

Biological—includes everything in the body, from molecules and DNA to the internal organs and nervous system

Psychological—includes personality, behaviors, learning and coping skills, emotions, and overall mental health

Social—includes all relationships (eg, with family, friends, coworkers, and social support network), as well as environmental influences (like cultural background and education)

For better or worse, a person’s thoughts, emotions, behaviors, beliefs, living situation, relationships, and family dynamics can also influence low back pain.[2] That’s why chronic low back pain may not respond as well to a single type of treatment that just focuses on the physical cause (such as massage therapy or muscle relaxants). Therefore, chronic low back pain can benefit greatly from a multipronged approach that takes all 3 biopsychosocial factors into account. Multimodal rehabilitation, or MMR, is one such treatment approach.[3]

What is MMR?

MMR is a holistic, comprehensive approach used for addressing many conditions, including chronic low back pain. (“Holistic” means that it looks at the whole person and takes all 3 biopsychosocial factors into account.) MMR is the gold standard approach for back pain in Europe, where it’s usually done in a clinic setting.[4] MMR has been steadily gaining more traction in the US for the management of chronic low back pain. In fact, the ACP recommends trying MMR before medication in its treatment guidelines for low back pain.[1]

As indicated by its name, traditional MMR draws upon the skills of a dedicated team of different healthcare professionals who work closely together to coordinate treatment.[5] For example, a person receiving MMR may see a physician, physical therapist, and psychologist, as well as yoga and meditation instructors. The traditional MMR model has been slower to catch on in the US due to the costs involved with people seeing multiple healthcare practitioners.

Goals of MMR

MMR strives to restore a person’s ability to function in everyday life. It also seeks to help people create their own pain-management strategies.[6] Another goal of MMR is that it looks to prevent acute pain from developing into chronic pain. This is because the interaction of biopsychosocial factors can increase the chances of acute pain becoming chronic. For example, a combination of workplace stress, faltering quality of life, depression, anxiety, or worry can increase the risk of acute pain becoming chronic.[7]

Benefits of MMR

In studies, MMR has demonstrated some impressive benefits over conventional low back pain treatments. In a review of 41 clinical trials of MMR for chronic low back pain, researchers found MMR was more effective at decreasing pain and disability than the usual care for low back pain. What’s more, the review found that people who received MMR were more likely to get back to work compared with people who only received physical treatment. The review also found that people who received MMR had similar outcomes as people who opted for surgery to treat their back pain. However, the MMR group had a leg up over the surgery group—they were less likely to have adverse events.[3]

MMR and the Kaia Pain app

The upside of traditional MMR (that is, MMR done in a clinic setting) is that it’s comprehensive. A downside is that it can be a lot for people to coordinate multiple appointments with different practitioners. This can add extra time and cost, too. That’s where the Kaia Pain app comes in. The Kaia Pain app is based on MMR, incorporating physical exercises, relaxation practices, and theory modules. Plus, the app includes access to a Kaia Coach, who’s there to guide you through your program every step of the way. And, unlike traditional MMR, it’s all at your fingertips!

Kaia Health has taken the key aspects of MMR while removing many of the obstacles to getting it. You can do your Kaia exercises anytime, anywhere, right from your smartphone. Even the busiest person can make their back health a priority with the Kaia Back Pain app. It was designed to be as convenient and easy to use as possible.


MMR is based on the motto “Helping people help themselves.” Ultimately, it’s about empowering people to actively address their low back pain. MMR offers a wide range of strategies that can make a big difference. The Kaia Pain app, which is based on MMR, uses physical exercises, relaxation practices, and theory modules to help make it easier than ever to get you back on track to back health.


  1. Qaseem A, Wilt TJ, McLean RM, Forceia MA; Clinical Guidelines Committee of the American College of Physicians. Noninvasive treatments for acute, subacute, and chronic low back pain: a clinical practice guideline from the American College of Physicians. Ann Intern Med. 2017;166(7):514-530.
  2. Physiopedia. Biopsychosocial model. Physiopedia website. Accessed April 29, 2019.
  3. Kamper SJ, Apeldoorn AT, Chiarotto A, et al. Multidisciplinary biopsychosocial rehabilitation for chronic low back pain: Cochrane systematic review and meta-analysis. BMJ. 2015;350:h444.
  4. Böger A. Multimodal pain therapy [in German]. Versicherungsmedizin. 2014;66(2):72-78.
  5. Morlion B, Pergolizzi J, Huygen F. The burden of chronic noncancer pain. In: Pergolizzi J, ed. Towards a Multidisciplinary Approach in Chronic
    Pain Management. Published 2011. Accessed April 29, 2019.
  6. Schütze A, Kaiser U, Ettrich U, et al. Evaluation of a multimodal pain therapy at the University Pain Centre Dresden [in German]. Der Schmerz. 2009;23(6):609-617.
  7. Koes BW, van Tulder MW, Thomas S. Diagnosis and treatment of low back pain. BMJ. 2006;332(7555):1430-1434.

Further Reading