Peter Lurie
Since then, whether as a physician, academic researcher, or federal official, his work has often focused on ridding the food supply of toxic chemicals. As the president and executive director of Center for Science in the Public Interest (CSPI), he directed his organization in 2022 to petition the FDA to ban Red Dye #3. But from previously working at the FDA, Lurie knew that their best shot was to pressure the agency—through the states.
In California, CSPI helped develop legislation that led to a state-level ban and the removal of certain food dyes from the school meal program in 2024. After four decades, Lurie was 'thrilled' when the FDA finally passed a federal ban. Just weeks later, his team successfully helped pressure the agency to define 'healthy' food labels, so that they better align with nutrition science. 'Most people believe the government is protecting them, but it often isn't,' Lurie says. 'That's where we step in.'
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For both measures, the differences between the two CFT groups were not significant. Sensitivity analyses showed similar, although slightly smaller, effects. In addition, 49% of the CFT plus biofeedback and 43% of the CFT-only groups maintained recovery level scores between the 1-year and 3-year follow-ups compared with 17% of the usual care group. 'These long-term effects are novel and provide the opportunity to markedly reduce the effect of chronic back pain if the intervention can be widely implemented,' the investigators wrote. They noted that this would include an increase in clinician training and replication studies in other populations. 'This type of biopsychosocial intervention is widely recommended in guidelines, but the evidence [for it] is now becoming much stronger,' Hancock said. 'Many clinicians aim to deliver these interventions, but they often find it hard, especially if they were trained in a more pure biomedical way of thinking. There are now more resources to assist clinicians in upskilling in these approaches,' he added. 'Cautious Optimism' In an accompanying editorial, Dimitrios Lytras, PhD, Department of Physiotherapy, International Hellenic University, Thessaloniki, Greece, applauded how the study was conducted. 'Methodologically, RESTORE is exemplary: a pragmatic, multicenter trial embedded in routine care [and] supported by thorough therapist training,' Lytras wrote. He added that the results 'offer cautious optimism' and a shift from passive care models to ones that are more patient-centered. The addition of biofeedback not leading to added benefit could be explained by the fact that CFT 'already incorporates rich feedback mechanisms, making supplementary sensor input redundant,' he noted. Lytras wrote that the intervention is also low risk and high value. Durable Functional Gains Commenting for Medscape Medical News, Sean Mackey, MD, PhD, Redlich professor and chief of the Division of Pain Medicine at Stanford Medicine, Palo Alto, California, said the study showed durable functional gains and modest pain changes. The dose of seven visits over 12 weeks plus a 26-week booster was 'lean,' but the effects held, which was 'pleasantly surprising,' said Mackey, who was not involved with the research. However, he did note a few caveats, including that only 63% of the randomized cohort contributed to the 3-year data. In addition, 'those followed were less severe at baseline and did better at 1 year, though loss to follow-up was nondifferential by arm,' he said. In reflecting on the study design, Mackey noted that an 'attention-matched active comparator to blunt performance and expectancy bias' would have been helpful. He pointed out that the researchers themselves acknowledged that usual care was not contact-matched. He added that it would also have been valuable to include data on 3-year adverse events, healthcare utilization, and costs. If future research confirms its generalizability to other countries, Mackey said he would recommend clinicians 'adopt the CFT package' of graded exposure with a control and lifestyle coaching, schedule 6-8 visits plus a 6-month booster, measure function as the primary outcome, and set expectations for about a one-point reduction in pain. He recommended against adding sensor biofeedback because 'it didn't help.'
