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Smith WR, Valrie CR, Jaja C, Kenney MO. Precision, integrative medicine for pain management in sickle cell disease. Front Pain Res (Lausanne) 2023; 4:1279361. [PMID: 38028431 PMCID: PMC10666191 DOI: 10.3389/fpain.2023.1279361] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Accepted: 10/24/2023] [Indexed: 12/01/2023] Open
Abstract
Sickle cell disease (SCD) is a prevalent and complex inherited pain disorder that can manifest as acute vaso-occlusive crises (VOC) and/or chronic pain. Despite their known risks, opioids are often prescribed routinely and indiscriminately in managing SCD pain, because it is so often severe and debilitating. Integrative medicine strategies, particularly non-opioid therapies, hold promise in safe and effective management of SCD pain. However, the lack of evidence-based methods for managing SCD pain hinders the widespread implementation of non-opioid therapies. In this review, we acknowledge that implementing personalized pain treatment strategies in SCD, which is a guideline-recommended strategy, is currently fraught with limitations. The full implementation of pharmacological and biobehavioral pain approaches targeting mechanistic pain pathways faces challenges due to limited knowledge and limited financial and personnel support. We recommend personalized medicine, pharmacogenomics, and integrative medicine as aspirational strategies for improving pain care in SCD. As an organizing model that is a comprehensive framework for classifying pain subphenotypes and mechanisms in SCD, and for guiding selection of specific strategies, we present evidence updating pain research pioneer Richard Melzack's neuromatrix theory of pain. We advocate for using the updated neuromatrix model to subphenotype individuals with SCD, to better select personalized multimodal treatment strategies, and to identify research gaps fruitful for exploration. We present a fairly complete list of currently used pharmacologic and non-pharmacologic SCD pain therapies, classified by their mechanism of action and by their hypothesized targets in the updated neuromatrix model.
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Affiliation(s)
- Wally R. Smith
- Division of General Internal Medicine, Virginia Commonwealth University, Richmond, VA, United States
| | - Cecelia R. Valrie
- Department of Psychology, Virginia Commonwealth University, Richmond, VA, United States
| | - Cheedy Jaja
- College of Nursing, University of South Florida School of Nursing, Tampa, FL, United States
| | - Martha O. Kenney
- Department of Anesthesiology, Duke University, Durham, NC, United States
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2
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Suputtitada A, Chen CPC, Pongpirul K, Wang X. Mechanical Needling with Sterile Water versus Steroids Injection for Facet Joint Syndrome: A Retrospective Observational Study. Pain Res Manag 2022; 2022:1-10. [DOI: 10.1155/2022/9830766] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Objective. This present study aimed to explore the clinical effects of ultrasound-guided (USG) mechanical needling with sterile water injection for lumbar facet joint syndrome. Methods. This was a retrospective cohort study that assessed the clinical outcome of ageing patients who received USG mechanical needling with sterile water injection. In addition, the clinical outcome of age- and gender-matched patients randomly selected from patients who received mechanical needling with sterile water was compared to the patients injected with steroids in a 2 : 1 ratio. The data were extracted from the medical records of ageing patients with facet joint syndrome who received USG injection at the lumbosacral spine by the first author. Low back pain or axial pain, and leg pain or radicular pain were assessed by the visual analogue scale (VAS), and gait ability with walking distance was obtained at 6 different time points. Results. A total of 4,276 medical records were examined. Four thousand two hundred twenty-eight ageing patients received needling with sterile water injection and found that the efficacy lasted up to 6 months. Ninety-six patients were compared with 48 patients who received steroid injection. Those who received steroids had less back and leg pain at 1 week after injection; however, pain returned at 3 months and 6 months after injection. Conclusions. USG mechanical needling with sterile water could help relieve axial and radicular pain for at least 6 months. Reduced sensitization and removal of calcification and fibrosis were all possible mechanisms.Keywords: Mechanical needling, Sterile water, Ultrasound guided (USG) injection, Facet joint syndrome, Pain
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3
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Sahoo J, Jena D, Viswanath A, Barman A. Injection Botulinum Toxin A in Treatment of Resistant Chronic Low Back Pain: A Prospective Open-Label Study. Cureus 2021; 13:e17811. [PMID: 34660021 PMCID: PMC8500249 DOI: 10.7759/cureus.17811] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/07/2021] [Indexed: 11/27/2022] Open
Abstract
Objective The aim of this study was to evaluate the effect of botulinum toxin A (BTX-A) injection on patients with chronic low back pain (CLBP). Design In this open-label prospective study, patients with CLBP who satisfied inclusion and exclusion criteria received 100 units of BTX-A injection. Patients were followed up at four weeks, three months, and six months after injection. Pain and function were assessed with visual analog scale (VAS), Roland-Morris Disability Scale (RMS), and Oswestry Disability Index (ODI) at baseline and subsequent visits. Results A total of 19 participants with a mean age of 41.11 years completed the study. Compared to baseline, a significant improvement in all scores was observed that persisted up to six months post-injection (P<0.001). Only two patients reported transient injection site pain that improved over two to three days without any treatment. Conclusion BTX-A injection is safe and improves pain and function in patients with resistant CLBP. The effects are more beneficial when the population is more homogenous in diagnosis and devoid of negative predictors for the outcome.
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Affiliation(s)
- Jagannatha Sahoo
- Physical Medicine and Rehabilitation, All India Institute of Medical Sciences, Bhubaneswar, IND
| | - Debasish Jena
- Physical Medicine and Rehabilitation, All India Institute of Medical Sciences, Bhubaneswar, IND
| | - Amrutha Viswanath
- Physical Medicine and Rehabilitation, All India Institute of Medical Sciences, Bhubaneswar, IND
| | - Apurba Barman
- Physical Medicine and Rehabilitation, All India Institute of Medical Sciences, Bhubaneswar, IND
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Boecking B, Rose M, Brueggemann P, Mazurek B. Two birds with one stone.-Addressing depressive symptoms, emotional tension and worry improves tinnitus-related distress and affective pain perceptions in patients with chronic tinnitus. PLoS One 2021; 16:e0246747. [PMID: 33705407 PMCID: PMC7951911 DOI: 10.1371/journal.pone.0246747] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2020] [Accepted: 01/26/2021] [Indexed: 01/02/2023] Open
Abstract
BACKGROUND Psychological factors link the co-occurrence of tinnitus-related distress and pain perceptions in patients with chronic tinnitus. OBJECTIVE This study examines, if treatment-related changes in these factors ameliorate both tinnitus-related distress and pain perceptions in a sample of patients with chronic tinnitus. METHODS N = 1238 patients with chronic tinnitus provided pre- and post-treatment ratings of tinnitus-related distress and affective or sensory pain perceptions alongside measures of depressive symptoms and perceived stress. Treatment comprised an intensive tinnitus-specific multimodal treatment program. Using serial indirect-effects analyses, we examined association patterns between baseline values and change rates of those variables that were found to respond to treatment. RESULTS Small effect sizes emerged for changes in tinnitus-related distress, affective (but not sensory) pain perceptions, depressive symptoms, emotional tension and worry. At pre- or post-treatment respectively, baseline values and change rates intercorrelated. Across timepoints, (1) baseline tinnitus-related distress and affective pain perceptions were positively associated with improvements in tinnitus-related distress, affective pain perceptions and depressive symptoms. (2) Baseline depressive symptoms or emotional tension mediated positive associations between baseline tinnitus-related distress and improvement in affective pain perceptions. (3) Change in depressive symptoms mediated the effect of baseline tinnitus-related distress on change in affective pain perceptions-partly through associated change in emotional tension or worry. Mood-independent aspects of emotional tension were negatively associated with improvement in affective pain perceptions. CONCLUSIONS Depressive symptoms, emotional tension and worry emerge as key predictors of treatment response and transdiagnostic treatment targets for alleviating tinnitus-related distress and functionally associated affective pain perceptions.
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Affiliation(s)
- Benjamin Boecking
- Charité–Universitaetsmedizin Berlin—Tinnitus Center, Berlin, Germany
| | - Matthias Rose
- Division of Psychosomatic Medicine, Medical Department, Charité–Universitaetsmedizin Berlin, Berlin, Germany
| | - Petra Brueggemann
- Charité–Universitaetsmedizin Berlin—Tinnitus Center, Berlin, Germany
| | - Birgit Mazurek
- Charité–Universitaetsmedizin Berlin—Tinnitus Center, Berlin, Germany
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5
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Schega L, Kaps B, Broscheid KC, Bielitzki R, Behrens M, Meiler K, Drange S, Franke J. Effects of a multimodal exercise intervention on physical and cognitive functions in patients with chronic low back pain (MultiMove): study protocol for a randomized controlled trial. BMC Geriatr 2021; 21:151. [PMID: 33653286 PMCID: PMC7923646 DOI: 10.1186/s12877-021-02093-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2020] [Accepted: 02/16/2021] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Chronic low back pain (CLBP) is a common medical condition in adults over the age of 50. It is associated with severe disability, ranging from physical impairments to psychosocial distress. Since current treatments provide only small to moderate short-term effects, alternative interventions are required, whereby guidelines recommended multimodal approaches. Dancing can be considered as an inherently multimodal approach, as it requires a combination of physical and cognitive functions. Furthermore, it has already been applied effectively in neurorehabilitation. Therefore, it seems promising to merge a dance-therapeutic component together with motor-cognitive, strength and flexibility exercises in a novel multimodal treatment (MultiMove) to target the impaired everyday mobility and cognition of CLBP patients. The aim of this study is to analyse specific physical, cognitive and psychosocial effects of MultiMove in CLBP patients. METHODS A prospective, two-arm, single-blinded, randomized controlled trial will be conducted with an estimated sample size of 100 CLBP patients, assigned to either the MultiMove group or a control group. The intervention group will receive MultiMove twice a week for 60 min each over a period of 12 weeks. The primary outcome will be the mobility and function of the lower extremities assessed by the Timed Up-and-Go Test. Secondary outcomes comprise further physical and physiological functions (e.g. gait variability and haemodynamic response in the prefrontal cortex during motor-cognitive dual tasks), subjective health state (e.g. disability in daily life), executive functions (e.g. cognitive flexibility) and psychosocial aspects (e.g. kinesiophobia). Measures will be taken at baseline, after the intervention and at a 12-week follow-up. It is assumed that MultiMove improves the mentioned outcome parameters. DISCUSSION The combined assessment of changes in physical and cognitive functions as well as neuropsychological aspects in response to MultiMove will allow a better understanding of the motor-cognitive adaptations induced by multimodal exercises in CLBP patients. The specific conclusions will lead to recommendations for the conservative treatment approach in this clinically relevant patient group. TRIAL REGISTRATION German Clinical Trial Register (ID: DRKS00021696 / 10.07.2020), https://www.drks.de/drks_web/navigate.do?navigationId=trial.HTML&TRIAL_ID=DRKS00021696.
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Affiliation(s)
- Lutz Schega
- Health and Physical Activity, Department of Sport Science, Institute III, Otto von Guericke University Magdeburg, Zschokkestraße 32, 39104, Magdeburg, Germany
| | - Britta Kaps
- Health and Physical Activity, Department of Sport Science, Institute III, Otto von Guericke University Magdeburg, Zschokkestraße 32, 39104, Magdeburg, Germany.
| | - Kim-Charline Broscheid
- Health and Physical Activity, Department of Sport Science, Institute III, Otto von Guericke University Magdeburg, Zschokkestraße 32, 39104, Magdeburg, Germany
| | - Robert Bielitzki
- Health and Physical Activity, Department of Sport Science, Institute III, Otto von Guericke University Magdeburg, Zschokkestraße 32, 39104, Magdeburg, Germany
| | - Martin Behrens
- Health and Physical Activity, Department of Sport Science, Institute III, Otto von Guericke University Magdeburg, Zschokkestraße 32, 39104, Magdeburg, Germany
| | - Katharina Meiler
- Department of Orthopaedic Surgery, Klinikum Magdeburg gGmbH, Birkenallee 34, 39130, Magdeburg, Germany
| | - Steffen Drange
- Department of Orthopaedic Surgery, Klinikum Magdeburg gGmbH, Birkenallee 34, 39130, Magdeburg, Germany
| | - Jörg Franke
- Department of Orthopaedic Surgery, Klinikum Magdeburg gGmbH, Birkenallee 34, 39130, Magdeburg, Germany
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Abbey H, Nanke L, Brownhill K. Developing a psychologically-informed pain management course for use in osteopathic practice: The OsteoMAP cohort study. INT J OSTEOPATH MED 2021. [DOI: 10.1016/j.ijosm.2020.09.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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7
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Sturgeon JA, Langford D, Tauben D, Sullivan M. Pain Intensity as a Lagging Indicator of Patient Improvement: Longitudinal Relationships With Sleep, Psychiatric Distress, and Function in Multidisciplinary Care. The Journal of Pain 2021; 22:313-321. [DOI: 10.1016/j.jpain.2020.10.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Accepted: 10/12/2020] [Indexed: 12/21/2022]
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8
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Wang H, Grech C, Evans D, Jayasekara R. Education programs for people living with chronic pain: a scoping review. Frontiers of Nursing 2020; 7:307-19. [DOI: 10.2478/fon-2020-0040] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Abstract
Objective
The aim of this scoping review was to provide evidence for health practitioners to improve patient education practice for chronic pain management.
Methods
A scoping review was guided by Arksey and O'Malley's (2005)1 five-stage framework, investigated contemporary patient education programs (2007–2018) for chronic pain management in education content, formats of delivery, and tools used for evaluation. Content analysis and description were used for the outcome report.
Results
Seven quantitative studies were included. Education content consisted of General information, Cognitive behavior therapy (CBT), Self-management, and Pain neurophysiology (PN). Education delivery formats varied from workbook to workbook, face-to-face, online, when given for a group or individual or in a combined way. In total, 19 tools were reported for the evaluation of the education programs.
Conclusions
There is a variety in the education content and the delivery formats. The majority of programs showed effectiveness in patients’ chronic pain management based on their selected evaluation tools. This review showed that patient education programs can be useful in chronic pain management. The effectiveness of patient education programs focuses on the improved patients’ physical function and quality of life rather than the cessation of pain only.
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Abstract
The treatment of noncancer pain in the United States and globally is met with significant challenges, resulting in profound physical, emotional, and societal costs. Based on this need, numerous modalities have been proposed to manage chronic pain, including opioid and nonopioid interventions as well as surgical approaches. Thus, the future of pain management continues to be mired in evolving concepts and constant debates. Consequently, it is crucial to understand the past as we move towards the future. The evolution of lessons for better pain management at present and for the future starting from the 1990s to the present date are reviewed and emphasized with a focus on learning from the past for the future. This review summarizes the evolution of multiple modalities of treatments, including multidisciplinary programs, multimodal therapy, interventional techniques, opioid therapy, other conservative modalities, and surgical interventions. This review emphasizes the individual, patient-centered development of an effective pain treatment plan after proper evaluation to establish a diagnosis. It includes measurable outcomes that focus on improvements in the quality of life and activities of daily living, as well as improvement in pain and function and, most importantly, return to productive citizenship. It is crucial that the knowledge of best practices be advanced, along with emphasis on lessons learned in the past to provide best practices for better pain management.
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Affiliation(s)
- Laxmaiah Manchikanti
- Pain Management Centers of America, Paducah, KY, USA.
- University of Louisville, Louisville, KY, USA.
- Department of Anesthesiology, School of Medicine, LSU Health Sciences Center, New Orleans, LA, USA.
| | - Vanila Singh
- Department of Anesthesia, Stanford University, Stanford, CA, USA
| | - Alan D Kaye
- Department of Anesthesiology, School of Medicine, LSU Health Sciences Center, New Orleans, LA, USA
- Department of Anesthesiology, LSU School of Medicine, Shreveport, LA, USA
- Department of Anesthesiology, Tulane School of Medicine, New Orleans, LA, USA
| | - Joshua A Hirsch
- Department of Radiology, Massachusetts General Hospital, Boston, MA, USA
- Department of Radiology, Harvard Medical School, Boston, MA, USA
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10
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Trampe D, Gouteron A, Naaim A, Laroche D, Grelat M, Casillas JM. A tool to improve functional outcome assessment of a multimodal program for patients with chronic low back pain: A study on walk tests (at comfortable and fast speed). J Back Musculoskelet Rehabil 2020; 33:485-494. [PMID: 31561323 DOI: 10.3233/bmr-171019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Tools for functional assessment of chronic low back pain (LBP) are lacking. OBJECTIVE To determine the correlations and the responsiveness of the 400 m comfortable walk test (400 mCWT) and the 200 m fast-walk test (200 mFWT) in the functional assessment of a multimodal program. METHODS One hundred and twenty-seven participants (68 females) with LBP and with or without radicular pain completed a Quebec Back Pain Disability Scale, a Sorensen test, a Shirado test, a 400 mCWT and a 200 mFWT, at baseline and at the end of the program. RESULTS No significant side effect was reported during walk tests. Walking speed was significantly increased after the program (0.18 ± 0.15 m.s-1 for the 400 mCWT and 0.17 ± 0.17 m.s-1 for the 200 mFWT). Clinical parameters were also significantly improved (82.02 ± 83.1 seconds for the Shirado, 92.1 ± 100.1 seconds for the Sorensen, -14.0 ± 12.9 for the Quebec scale). A significant relationship was found between the increase in walking speed for the two walk tests and the improvement of the Quebec scale. The gait speed improvement was close to the minimal clinically important change (95% confidence interval: 0.14-0.22) determined from the Quebec scale threshold (minimum detectable change). CONCLUSIONS Both 400 mCWT and 200 mFWT are correlated with functional parameters and are responsive for the functional assessment of LBP.
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Affiliation(s)
- Delphine Trampe
- Department of Rehabilitation, University Hospital of Dijon, Dijon, France
| | - Anaïs Gouteron
- Department of Rehabilitation, University Hospital of Dijon, Dijon, France
| | - Alexandre Naaim
- CIC INSERM 1432, Plateforme d'Investigation Technologique, University Hospital of Dijon, Dijon, France
| | - Davy Laroche
- CIC INSERM 1432, Plateforme d'Investigation Technologique, University Hospital of Dijon, Dijon, France.,INSERM U1093, Dijon, France
| | - Mickael Grelat
- Department of Neurological Surgery, University Hospital of Dijon, Dijon, France
| | - Jean-Marie Casillas
- Department of Rehabilitation, University Hospital of Dijon, Dijon, France.,CIC INSERM 1432, Plateforme d'Investigation Technologique, University Hospital of Dijon, Dijon, France.,INSERM U1093, Dijon, France
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11
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Choji Y, Kobayashi R. Development of a Japanese Version of a Collaborative Relationship Scale between Clients and Occupational Therapists. Prog Rehabil Med 2020; 5:20200001. [PMID: 32789269 PMCID: PMC7365236 DOI: 10.2490/prm.20200001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2019] [Accepted: 01/19/2020] [Indexed: 11/09/2022] Open
Abstract
Objective: The success of a client-centred practice depends on the relationship between the
client and therapist and on their ability to make constructive decisions together,
particularly in the field of occupational therapy. The aim of this study was to develop
a Occupational Therapy Collaborative Relationship Scale (OTCRS) to measure the quality
of such interaction. Methods: This work included constructing a draft questionnaire and testing its validity and
reliability. A Rasch analysis was applied to determine its validity, and several tests
were used to confirm its internal consistency. Results: After reviewing more than 130 scientific papers and books, we built explicit selection
criteria for issues to be addressed in this instrument, and we developed 40 questions to
be included. These were analysed using a standard content validation process and a Rasch
analysis to examine confirmation validity. A nine-item scale was finalised for testing
(OTCRS-9). This review process revealed the validity, high internal consistency, and
item/person separation reliability of OTCRS-9. Conclusion: This study presents only the initial phase of scale development. As suggested by the
Consensus-based Standards for the Selection of Health Measurement Instruments (COSMIN),
the OTCRS-9 score should be tested further for validity and reliability and should also
be conducted in subjects of other ethnicities to improve its generalizability.
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Affiliation(s)
- Yuki Choji
- Department of Occupational Therapy, Graduate School of Human Health Sciences, Tokyo Metropolitan University, Tokyo, Japan.,Department of Occupational Therapy, Toyama Rehabilitation Medical Health and Welfare College, Toyama, Japan
| | - Ryuji Kobayashi
- Department of Occupational Therapy, School of Health Science, Tokyo Metropolitan University, Tokyo, Japan
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Thomas KA, Sedney C, Gross R. Support for a Three-Item Questionnaire Prior to Spinal Surgery: A Health-Related Quality of Life Outcome Study. J Neurosci Rural Pract 2020; 11:100-105. [PMID: 32140011 PMCID: PMC7055628 DOI: 10.1055/s-0039-3400348] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Objective
Elective lumbar and cervical operations are becoming more common in the United States. Additionally, there is a movement in the literature and clinical practice to discover short versions of longer measures as a way to anticipate an outcome. This study aims to provide neurosurgeons in practice with a three-item questionnaire that can guide referrals to psychological services presurgery. Ultimately, results could lead to an improvement in health-related quality of life (HRQoL) postspinal surgery.
Methods
This quantitative-descriptive, survey-based design with a retrospective chart review component followed 47 patients at baseline (
N
= 47), 3 months (
N
= 20), 6 months (
N
= 31), and 1 year (
N
= 19). A single item from the Coping Strategies Questionnaire, the Survey of Pain Attitudes, and the Tampa Scale of Kinesiophobia were utilized in the three-item questionnaire as a baseline measure. Patient-Reported Outcomes Measurement Information System Global Health measured HRQoL outcome at all time points. A linear regression model was conducted to predict mental health QoL postspinal surgery.
Results
This measure can predict mental health QoL outcomes up to 3-month postsurgery. Six-month and 1-year follow-ups are statistically inconclusive.
Conclusion
Individuals who are undergoing spinal surgery show lower mental health QoL outcome at baseline and 3-month postsurgery when responses on a three-item questionnaire are elevated. Limitations and future directions are discussed.
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Affiliation(s)
- Kelly Anne Thomas
- Department of Counseling, Rehabilitation Counseling, and Counseling Psychology, West Virginia University, Morgantown, West Virginia, United States
| | - Cara Sedney
- Department of Neurosurgery, West Virginia University, Morgantown, West Virginia, United States
| | - Richard Gross
- Department of Behavioral Medicine and Psychiatry, West Virginia University, Morgantown, West Virginia, United States
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Tederko P, Mycielski J, Angerova Y, Denes Z, Grabljevec K, Ilieva E, Ilieva A, Moslavac S, Popa D, Takac P, Krasuski M, Tarnacka B. Role of diversity in assembling of rehabilitation teams in Central Europe. Eur J Phys Rehabil Med 2020; 56:131-141. [PMID: 31939266 DOI: 10.23736/s1973-9087.20.05904-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Multiprofessional teamwork in physical and rehabilitation medicine (PRM) allows achieving patient-centered goals in accordance with the assumptions of the bio-psycho-social model of functioning. Team composition and methods of collaboration depend of the specificity of goals to be achieved, as well local contextual factors. International comparative studies on rehabilitation teamwork are lacking, despite data on how teams differ between countries are crucial for the process of harmonization of PRM practice across Europe. AIM To compare models of collaboration within rehabilitation teams in Central Europe. DESIGN A cross-sectional explorative study. SETTING The data were collected in Bulgaria, Croatia, Czech Republic, Hungary, Poland, Romania, Slovakia between February and June 2018. POPULATION PRM physicians. METHODS An anonymous questionnaire inquiring of rehabilitation teamwork details was spread through national PRM societies, and other organizations associating PRM physicians. An ordered logit regression was applied to analyze the results. RESULTS Responses were obtained from 455 respondents. Significant differences between the studied countries in the composition of rehabilitation teams and frequencies of team meetings were detected. In the analyzed population of PRM physicians, we found positive associations between the chance of participation in team meetings and working in a hospital, the amount of time devoted to PRM practice, and older age. The chance for patients and caregivers to participate in rehabilitation team meetings was correlated with PRM physician's hospital practice, activity as a PRM teacher, older age and devoting more time to PRM practice. Country specificities of rehabilitation team content were analyzed with regards to local economic, legal, and historical backgrounds, and availability of human resources. Underrepresentation of key professionals (e.g. occupational therapists, orthotists/prosthetists), inadequate distribution of professionals in healthcare and as well as outdated educational systems in some countries may affect the efficacy of the comprehensive care in rehabilitation. CONCLUSIONS Central European countries differ in rehabilitation teamwork with regard to the contribution of professionals, meeting frequencies, and participation of patients and caregivers. Well-designed studies on teamwork models delineating ways to improve teamwork efficacy are in demand. CLINICAL REHABILITATION IMPACT Between-country diversity of rehabilitation team content should be considered while planning activities aimed at European harmonization of PRM practice.
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Affiliation(s)
- Piotr Tederko
- Department of Rehabilitation, Faculty of Medicine, Medical University of Warsaw, Warsaw, Poland - .,Polish Rehabilitation Society, Warsaw, Poland -
| | - Jerzy Mycielski
- Department of Econometrics and Statistics, Faculty of Economics, University of Warsaw, Warsaw, Poland
| | - Yvona Angerova
- Department of Rehabilitation Medicine, First Faculty of Medicine, Charles University, and General Teaching Hospital, Prague, Czech Republic
| | - Zoltan Denes
- National Institute for Medical Rehabilitation, Budapest, Hungary
| | | | - Elena Ilieva
- Department of Physical and Rehabilitation Medicine, Faculty of Medicine, Medical University of Plovdiv, Plovdiv, Bulgaria
| | - Aleksandra Ilieva
- Department of Physical and Rehabilitation Medicine, Faculty of Medicine, Medical University of Plovdiv, Plovdiv, Bulgaria
| | - Sasa Moslavac
- Spinal Unit, Special Hospital for Medical Rehabilitation, Varazdinske Toplice, Croatia
| | - Daiana Popa
- Clinical Rehabilitation Hospital Felix Spa, Oradea, Romania
| | - Peter Takac
- Department of Physiatry, Balneology and Medical Rehabilitation, Faculty of Medicine, P. J. Safarik University and L. Pasteur University Hospital, Kosice, Slovak Republic
| | - Marek Krasuski
- Polish Rehabilitation Society, Warsaw, Poland.,Private Practitioner, Warszaw, Poland
| | - Beata Tarnacka
- Department of Rehabilitation, Faculty of Medicine, Medical University of Warsaw, Warsaw, Poland.,Polish Rehabilitation Society, Warsaw, Poland
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Gliedt JA, Mardian AS. Making strides toward achieving the Triple Aim in the treatment of chronic low back pain with a biopsychosocial guided approach. Musculoskeletal Care 2019; 17:372-375. [PMID: 31419010 DOI: 10.1002/msc.1423] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2019] [Revised: 07/09/2019] [Accepted: 07/12/2019] [Indexed: 06/10/2023]
Abstract
The Triple Aim is an effort to bring attention to improving the patient experience, improving population health and reducing healthcare costs. Chronic pain, particularly chronic low back pain, is a common disabling condition with high costs and burdens to society. The biopsychosocial model may provide a framework in which chronic low back pain may be viewed to guide new and emerging clinical care models to achieve the Triple Aim in this field of care.
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Affiliation(s)
- Jordan A Gliedt
- Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Aram S Mardian
- Phoenix Veterans Affairs Health Care System, Phoenix, AZ, USA
- College of Medicine - Phoenix, University of Arizona, Phoenix, AZ, USA
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15
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Hüppe A, Zeuner C, Karstens S, Hochheim M, Wunderlich M, Raspe H. Feasibility and long-term efficacy of a proactive health program in the treatment of chronic back pain: a randomized controlled trial. BMC Health Serv Res 2019; 19:714. [PMID: 31639016 PMCID: PMC6805578 DOI: 10.1186/s12913-019-4561-8] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2018] [Accepted: 09/25/2019] [Indexed: 01/08/2023] Open
Abstract
Background To facilitate access to evidence-based care for back pain, a German private medical insurance offered a health program proactively to their members. Feasibility and long-term efficacy of this approach were evaluated. Methods Using Zelen’s design, adult members of the health insurance with chronic back pain according to billing data were randomized to the intervention (IG) or the control group (CG). Participants allocated to the IG were invited to participate in the comprehensive health program comprising medical exercise therapy and life style coaching, and those allocated to the CG to a longitudinal back pain survey. Primary outcomes were back pain severity (Korff’s Chronic Pain Grade Questionnaire) as well as health-related quality of life (SF-12) assessed by identical online questionnaires at baseline and 2-year follow-up in both study arms. In addition to analyses of covariance, a subgroup analysis explored the heterogeneity of treatment effects among different risks of back pain chronification (STarT Back Tool). Results Out of 3462 persons selected, randomized and thereafter contacted, 552 agreed to participate. At the 24-month follow-up, data on 189 of 258 (73.3%) of the IG were available, in the CG on 255 of 294 (86.7%). Significant, small beneficial effects were seen in primary outcomes: Compared to the CG, the IG reported less disability (1.6 vs 2.0; p = 0.025; d = 0.24) and scored better at the SF-12 physical health scale (43.3 vs 41.0; p < 0.007; d = 0.26). No effect was seen in back pain intensity and in the SF-12 mental health scale. Persons with medium or high risk of back pain chronification at baseline responded better to the health program in all primary outcomes than the subgroup with low risk at baseline. Conclusions After 2 years, the proactive health program resulted in small positive long-term improvements. Using risk screening prior to inclusion in the health program might increase the percentage of participants deriving benefits from it. Trial registration The trial was registered at the German Clinical Trials Register under DRKS00015463 retrospectively (dated 4 Sept 2018).
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Affiliation(s)
- A Hüppe
- Institute of Social Medicine and Epidemiology, University of Lübeck, Ratzeburger Allee 160, 23562, Lübeck, Germany.
| | - C Zeuner
- Institute of Social Medicine and Epidemiology, University of Lübeck, Ratzeburger Allee 160, 23562, Lübeck, Germany
| | - S Karstens
- Department of Computer Science, Therapeutic Science, Trier University of applied Science, Schneidershof, 54293, Trier, Germany
| | - M Hochheim
- Generali Health Solutions GmbH, Hansaring 40-50, 50670, Köln, Germany
| | - M Wunderlich
- Central Krankenversicherung AG, Strategisches Leistungs- und Gesundheitsmanagement, Hansaring 40-50, 50670, Köln, Germany
| | - H Raspe
- Institute for Ethics, History and Theory of Medicine , University of Münster, von Esmarch-Straße 62, 48149, Münster, Germany
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16
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Dragioti E, Björk M, Larsson B, Gerdle B. A Meta-Epidemiological Appraisal of the Effects of Interdisciplinary Multimodal Pain Therapy Dosing for Chronic Low Back Pain. J Clin Med 2019; 8:jcm8060871. [PMID: 31216757 PMCID: PMC6616996 DOI: 10.3390/jcm8060871] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2019] [Revised: 06/13/2019] [Accepted: 06/17/2019] [Indexed: 11/17/2022] Open
Abstract
Using a meta-analysis, meta-regression, and a meta-epidemiological approach, we conducted a systematic review to examine the influence of interdisciplinary multimodal pain therapy (IMPT) dosage on pain, disability, return to work, quality of life, depression, and anxiety in published randomised controlled trials (RCTs) in patients with non-specific chronic low back pain (CLBP). We considered all RCTs of IMPT from a Cochrane review and searched PubMed for additional RCTs through 30 September 2018. A subgroup random-effects meta-analysis by length, contact, and intensity of treatment was performed followed by a meta-regression analysis. Using random and fixed-effect models and a summary relative odds ratio (ROR), we compared the effect sizes (ES) from short-length, non-daily contact, and low-intensity RCTs with long-length, daily contact, and high-intensity RCTs. Heterogeneity was quantified with the I2 metric. A total of 47 RCTs were selected. Subgroup meta-analysis showed that there were larger ES for pain and disability in RCTs with long-length, non-daily contact, and low intensity of treatment. Larger ES were also observed for quality of life in RCTs with short-length, non-daily contact, and low intensity treatment. However, these findings were not confirmed by the meta-regression analysis. Likewise, the summary RORs were not significant, indicating that the length, contact, and intensity of treatment did not have an overall effect on the investigated outcomes. For the outcomes investigated here, IMPT dosage is not generally associated with better ES, and an optimal dosage was not determined.
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Affiliation(s)
- Elena Dragioti
- Pain and Rehabilitation Centre, and Department of Medical and Health Sciences, Linköping University, SE-581 85 Linköping, Sweden.
| | - Mathilda Björk
- Pain and Rehabilitation Centre, and Department of Medical and Health Sciences, Linköping University, SE-581 85 Linköping, Sweden.
- Division of Occupational Therapy, Department of Social and Welfare Studies, Faculty of Health Sciences, Campus Norrkoping, Linköping University, SE-60174 Linköping, Sweden.
| | - Britt Larsson
- Pain and Rehabilitation Centre, and Department of Medical and Health Sciences, Linköping University, SE-581 85 Linköping, Sweden.
| | - Björn Gerdle
- Pain and Rehabilitation Centre, and Department of Medical and Health Sciences, Linköping University, SE-581 85 Linköping, Sweden.
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Gilron I, Blyth FM, Degenhardt L, Di Forti M, Eccleston C, Haroutounian S, Moore A, Rice ASC, Wallace M. Risks of harm with cannabinoids, cannabis, and cannabis-based medicine for pain management relevant to patients receiving pain treatment: protocol for an overview of systematic reviews. Pain Rep 2019; 4:e742. [PMID: 31583357 DOI: 10.1097/PR9.0000000000000742] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2019] [Revised: 03/06/2019] [Accepted: 03/09/2019] [Indexed: 01/08/2023] Open
Abstract
Supplemental Digital Content is Available in the Text. Introduction: With the increasing availability of cannabis and cannabinoids and their potential utility for pain treatment, there is a growing need to evaluate the risk-benefit considerations of cannabinoids for the management of pain. As part of the IASP Cannabis and Cannabinoids Task Force, this protocol describes a planned overview of systematic reviews summarizing the risks of harm with cannabinoids that are relevant to patients receiving pain treatment. Methods: This overview will involve literature searches of several databases and a defined search strategy that will target systematic reviews or meta-analyses of cannabinoids where harms are the primary focus. Data extraction will include various features of the cannabinoid(s) and the harm(s) being studied as well as other methodological features of each included systematic review. Methodological quality of each included review will be assessed using AMSTAR-2 as well as compliance with the PRISMA harms checklist. Prospero registration pending. Discussion: The broad overview of reviews defined by this protocol is expected to synthesize available good quality evidence of harms that will help inform risk-benefit considerations about the use of cannabinoids for pain management.
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18
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Tadano S, Tanabe H, Arai S, Fujino K, Doi T, Akai M. Lumbar mechanical traction: a biomechanical assessment of change at the lumbar spine. BMC Musculoskelet Disord 2019; 20:155. [PMID: 30961554 DOI: 10.1186/s12891-019-2545-9] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2018] [Accepted: 03/28/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Lumbar traction is a traditional treatment modality for chronic low back pain (CLBP) in many countries. However, its effectiveness has not been demonstrated in clinical practice because of the following: (1) the lack of in vivo biomechanical confirmation of the mechanism of lumbar traction that occurs at the lumbar spine; (2) the lack of a precise delivery system for traction force and, subsequently, the lack of reproducibility; and (3) few randomized controlled trials proving its effectiveness and utility. METHODS This study was planned as a preparatory experiment for a randomized clinical trial, and it aimed (1) to examine the biomechanical change at the lumbar area under lumbar traction and confirm its reproducibility and accuracy as a mechanical intervention, and (2) to reconfirm our clinical impression of the immediate effect of lumbar traction. One hundred thirty-three patients with non-specific CLBP were recruited from 28 orthopaedic clinics to undergo a biomechanical experiment and to assess and determine traction conditions for the next clinical trial. We used two types of traction devices, which are commercially available, and incorporated other measuring tools, such as an infrared range-finder and large extension strain gauge. The finite element method was used to analyze the real data of pelvic girdle movement at the lumbar spine level. Self-report assessments with representative two conditions were analyzed according to the qualitative coding method. RESULTS Thirty-eight participants provided available biomechanical data. We could not measure directly what happened in the body, but we confirmed that the distraction force lineally correlated with the movement of traction unit at the pelvic girdle. After applying vibration force to preloading, the strain gauge showed proportional vibration of the shifting distance without a phase lag qualitatively. FEM simulation provided at least 3.0-mm shifting distance at the lumbar spine under 100 mm of body traction. Ninety-five participants provided a treatment diary and were classified as no pain, improved, unchanged, and worsened. Approximately 83.2% of participants reported a positive response. CONCLUSION Lumbar traction can provide a distractive force at the lumbar spine, and patients who experience the application of such force show an immediate response after traction. TRIAL REGISTRATION University Hospital Medical Information Network - Clinical Trial Registration: UMIN-CTR000024329 (October 13, 2016).
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Abstract
The issue of pain warrants attention as, by virtue of having an intellectual disability, a person may have associated medical or physical conditions and associated factors increasing their risk of pain disorders. People with intellectual disability experiencing pain need to be provided with the best possible care. The focus of this article is on the exploration of pain: physiology and types; manifestations and responses in the context of intellectual disability in order to promote effective, knowledgeable assessment and management of pain for this client group. Pain is a subjective, complex, physiological and psychological phenomenon that can be acute or chronic and may be classified according to its cause. Within the experience of pain, the concept of total pain describes the physical, psychological, social and spiritual factors that influence the experience of pain.
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Raghunandan A, Chang Chien GC. Importance of Early Intervention and Early Return to Work in Reducing Absence. Pain 2019. [DOI: 10.1007/978-3-319-99124-5_226] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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21
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Steinmetz A, Psczolla M, Seidel W, Niemier K, Derlien S, Nisser J. Effect of subgroup-specific multimodal therapy on chronic spinal back pain and function-a prospective inpatient multicentre clinical trial in Germany. Medicine (Baltimore) 2019; 98:e13825. [PMID: 30608395 PMCID: PMC6344159 DOI: 10.1097/md.0000000000013825] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Treatment modalities of spinal pain patients are discussed diversely, and different multimodal therapy programs have been developed. Purpose of the present study was to evaluate therapy outcome and effectiveness of an inpatient interdisciplinary and multimodal treatment program.This prospective multicentre clinical trial has been performed with patients from orthopedic hospitals receiving a functional musculoskeletal therapy pathway. Outcome measures were pain intensity and back-specific function (Oswestry Disability Index) before (T1) and after the intervention (T2) as well as after 6 and 12 months (T3, T4). Statistical approach included parametric (t test) and nonparametric (Wilcoxon-test) tests and the calculation of effect sizes. Additionally, a statistical subgroup analysis based on selected parameters (degree of pain chronicity, gender, and age) was performed using linear mixed models.In total, 249 patients (42.6% men, 57.4% women) with spinal pain were included, 133 patients were accessible for follow-up at T3 and 106 patients at T4.Average pain (AP) reduced significantly (P <.001) from T1 to T4 with an effect size of 0.99. Back-specific function also improved (P <.001) over all measuring time points (TP) (effect size: 0.63). Furthermore, the statistical subgroup analysis demonstrated the efficacy of the treatment concept within the subgroup parameters chronicity degree and age.A functional musculoskeletal therapy pathway including treatment of musculoskeletal dysfunctions appears to be beneficial in terms of treating pain and function. Pain chronicity and age seems to be factors influencing therapy outcome. Further studies are needed to examine the superiority of these inpatient programs for back pain including control groups.
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Affiliation(s)
- Anke Steinmetz
- Loreley Hospital of Conservative Orthopaedics and Center for Musculoskeletal Medicine, St. Goar-Oberwesel
| | - Matthias Psczolla
- Loreley Hospital of Conservative Orthopaedics and Center for Musculoskeletal Medicine, St. Goar-Oberwesel
| | | | - Kay Niemier
- Spine Center, Hamburg
- Hospital of Manual Therapy, Hamm
| | | | - Jenny Nisser
- Jena University Hospital, Institute of Physiotherapy
- Research Consulting Office Manual Medicine, Jena, Germany
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22
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Vinas-Rios JM, Sanchez-Aguilar M, Medina Govea FA, Von Beeg-Moreno V, Meyer F. Incidence of early postoperative complications requiring surgical revision for recurrent lumbar disc herniation after spinal surgery: a retrospective observational study of 9,310 patients from the German Spine Register. Patient Saf Surg 2018; 12:9. [PMID: 29942349 PMCID: PMC5961485 DOI: 10.1186/s13037-018-0157-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2017] [Accepted: 03/26/2018] [Indexed: 11/10/2022] Open
Abstract
Background The recurrence rate in lumbar disc herniations (LDH) has been reported between 5 and 25%. There are only few data about this phenomenon that occurs within days of the initial operation. We analyse early recurrent LDH by analysis of data from the German Spine register. Methods Data from patients undergoing disc herniation surgery in the lumbar region were extracted from the German Spine Registry between 1st January 2012 and 31st December 2016. Patients with early recurrent LDH within days of initial surgery were separately analysed. Results A total of 9310 surgeries for LDH were documented in the German Spine Register. From these patients 115 (1.2%) presented an early recurrent disc surgeries within days of the initial surgery. The mean age was 70 ± 2.50 years. Most affected segment was L4/5 (47 cases, 41%), followed by L3/4 (45 cases, 39%). The most of our patients showed a normal or overweight Body Mass Index. Surgery for early recurrent LDH was associated with a high rate of incidental durotomies (20 cases, 17.6%). In 3 cases (2.6%) therapy with a lumbar drain was necessary. Conclusions The rate of early recurrent LDH within days of surgery is 1.2%. Age seems to be an important factor in early recurrent LDH while obesity does not. The data of the German Spine Register seems to have a reliable data collection system that can perform multicentre data analysis. The databases from this Register could be used in the future for various purposes, such as the evaluation of multicentre surgical techniques, results in patients with various surgical procedures and basic research in spine surgery.
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Affiliation(s)
| | | | | | | | - Frerk Meyer
- University Clinic Evangelical Hospital Oldenburg, Oldenburg, Germany
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Mordecai L, Reynolds C, Donaldson LJ, de C Williams AC. Patterns of regional variation of opioid prescribing in primary care in England: a retrospective observational study. Br J Gen Pract 2018; 68:e225-33. [PMID: 29440012 DOI: 10.3399/bjgp18X695057] [Citation(s) in RCA: 82] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2017] [Accepted: 11/03/2017] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Opioids are a widely prescribed class of drug with potentially harmful short-term and long-term side effects. There are concerns about the amounts of these drugs being prescribed in England given that they are increasingly considered ineffective in the context of long-term non-cancer pain, which is one of the major reasons for their prescription. AIM To assess the amount and type of opioids prescribed in primary care in England, and patterns of regional variation in prescribing. DESIGN AND SETTING Retrospective observational study using publicly available government data from various sources pertaining to opioids prescribed in primary practice in England and Indices of Social Deprivation. METHOD Official government data were analysed for opioid prescriptions from August 2010 to February 2014. The total amount of opioid prescribed was calculated and standardised to allow for geographical comparisons. RESULTS The total amount of opioid prescribed, in equivalent milligrams of morphine, increased (r = 0.48) over the study period. More opioids were prescribed in the north than in the south of England (r = 0.66, P<0.0001), and more opioids were prescribed in areas of greater social deprivation (r = 0.56, P<0.0001). CONCLUSION Long-term opioid prescribing is increasing despite poor efficacy for non-cancer pain, potential harm, and incompatibility with best practice. Questions of equality of care arise from higher prescription rates in the north of England and in areas of greater social deprivation. A national registry of patients with high opioid use would improve patient safety for this high-risk demographic, as well as provide more focused epidemiological data regarding patterns of prescribing.
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Abstract
1. This article aims to provide a long-term update 2 years on from our initial paper and summarises service evaluation data collected from 21 pain management programmes, using a solution-focused approach in a community pain service. 2. An examination of the larger baseline and subsequent follow-up data suggests an improvement in participants' function, pain self-efficacy and mental well-being following CPS PMP, and corroborates the findings of the earlier dataset. 3. Additional findings suggest that CPS PMP may help pain interfere less in participants' lives (post-PMP and at 10-week follow-up) and that improvements in mental well-being and self-efficacy are maintained on a long-term basis (at 6- and 12-month follow-up). Limitations of the data are discussed. 4. The article also discusses the nature of community healthcare services for chronic pain, including how we view PMP treatment intensity, deliver cost effectiveness, measure outcomes and support patients post-PMP. 5. It is suggested that effective, meaningful PMPs can be facilitated successfully by multi-professional teams in the community, at arguably lower cost than secondary/tertiary settings, while enabling convenient and long-lasting integration of self-management into people's lives.
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Affiliation(s)
- Rebecca Simm
- Southport and Ormskirk Hospital NHS Trust, Southport, UK
| | - Chris Barker
- Southport and Ormskirk Hospital NHS Trust, Southport, UK
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25
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Abstract
Background: Multidisciplinary pain clinics are considered the gold standard for the treatment of chronic pain, yet access to such clinics is difficult and patients’ conditions deteriorate while waiting. Instituting a triage process is one way of reducing wait time for some patients and ensuring optimal access given the limited resources available. Surprisingly, there are no established guidelines on how to optimally triage chronic pain patients at tertiary multidisciplinary pain clinics. Aims: The goal of this study was to gather information regarding existing triage systems in multidisciplinary chronic pain clinics worldwide as an initial step toward establishing a definitive evidence-based set of triage guidelines. Methods: A total of 66 multidisciplinary pain clinics worldwide completed an online survey detailing current triage practices at their clinic. The survey was distributed via international and national pain associations. Results: Results showed that the vast majority of multidisciplinary pain clinics (94%) use a triage system, yet many difficulties with these systems have been identified (time requirement, administrative burden, lack of control over scheduling, missing high-priority patients, and prioritizing low-priority patients). The level of satisfaction was noted to be higher in those clinics using a structured triage template. Conclusions: This study identified a need for the elaboration of best practice clinical guidelines for triage processes at tertiary pain clinics. The use of a structured referral template could become a central element to such guidelines.
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Affiliation(s)
- M Gabrielle Pagé
- Alan Edwards Pain Management Unit, Montreal General Hospital, Montreal, Quebec, Canada
| | - Daniel Ziemianski
- Alan Edwards Pain Management Unit, Montreal General Hospital, Montreal, Quebec, Canada.,School of Physical and Occupational Therapy, McGill University, Montreal, Quebec, Canada
| | - Yoram Shir
- Alan Edwards Pain Management Unit, Montreal General Hospital, Montreal, Quebec, Canada.,Alan Edwards Center for Research on Pain, Genome Building, McGill University, Montreal, Quebec, Canada.,Department of Anesthesia, McGill University, MUHC, Montreal, Quebec, Canada
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Markozannes G, Aretouli E, Rintou E, Dragioti E, Damigos D, Ntzani E, Evangelou E, Tsilidis KK. An umbrella review of the literature on the effectiveness of psychological interventions for pain reduction. BMC Psychol 2017; 5:31. [PMID: 28859685 PMCID: PMC5580223 DOI: 10.1186/s40359-017-0200-5] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2017] [Accepted: 08/24/2017] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Psychological interventions are widely implemented for pain management and treatment, but their reported effectiveness shows considerable variation and there is elevated likelihood for bias. METHODS We summarized the strength of evidence and extent of potential biases in the published literature of psychological interventions for pain treatment using a range of criteria, including the statistical significance of the random effects summary estimate and of the largest study of each meta-analysis, number of participants, 95% prediction intervals, between-study heterogeneity, small-study effects and excess significance bias. RESULTS Thirty-eight publications were identified, investigating 150 associations between several psychological interventions and 29 different types of pain. Of the 141 associations based on only randomized controlled trials, none presented strong or highly suggestive evidence by satisfying all the aforementioned criteria. The effect of psychological interventions on reducing cancer pain severity, pain in patients with arthritis, osteoarthritis, rheumatoid arthritis, breast cancer, fibromyalgia, irritable bowel syndrome, self-reported needle-related pain in children/adolescents or with chronic musculoskeletal pain, chronic non-headache pain and chronic pain in general were supported by suggestive evidence. CONCLUSIONS The present findings reveal the lack of strong supporting empirical evidence for the effectiveness of psychological treatments for pain management and highlight the need to further evaluate the established approach of psychological interventions to ameliorate pain.
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Affiliation(s)
- Georgios Markozannes
- Department of Hygiene and Epidemiology, University of Ioannina School of Medicine, University Campus, 45110, Ioannina, Greece.
| | - Eleni Aretouli
- Lab of Cognitive Neuroscience, School of Psychology, Aristotle University of Thessaloniki, 54124, Thessaloniki, Greece
| | - Evangelia Rintou
- Department of Psychiatry, University of Ioannina School of Medicine, University Campus, 45110, Ioannina, Greece
| | - Elena Dragioti
- Department of Hygiene and Epidemiology, University of Ioannina School of Medicine, University Campus, 45110, Ioannina, Greece
| | - Dimitrios Damigos
- Department of Psychiatry, University of Ioannina School of Medicine, University Campus, 45110, Ioannina, Greece
| | - Evangelia Ntzani
- Department of Hygiene and Epidemiology, University of Ioannina School of Medicine, University Campus, 45110, Ioannina, Greece.,Center for Evidence Synthesis in Health, Department of Health Services, Policy and Practice, School of Public Health, Brown University, Providence, Rhode Island, 02903, USA
| | - Evangelos Evangelou
- Department of Hygiene and Epidemiology, University of Ioannina School of Medicine, University Campus, 45110, Ioannina, Greece.,Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, SW7 2AZ, UK
| | - Konstantinos K Tsilidis
- Department of Hygiene and Epidemiology, University of Ioannina School of Medicine, University Campus, 45110, Ioannina, Greece.,Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, SW7 2AZ, UK
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Björnsdóttir SV, Triebel J, Arnljótsdóttir M, Tómasson G, Valdimarsdóttir UA. Long-lasting improvements in health-related quality of life among women with chronic pain, following multidisciplinary rehabilitation. Disabil Rehabil 2017; 40:1764-1772. [DOI: 10.1080/09638288.2017.1312565] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Sigrún Vala Björnsdóttir
- Centre of Public Health Sciences, Faculty of Medicine, University of Iceland, Reykjavík, Iceland
- HNLFI Rehabilitation Clinic, Hveragerði, Iceland
| | - Jan Triebel
- HNLFI Rehabilitation Clinic, Hveragerði, Iceland
- Department of Orthopaedic Surgery, Akademiska, University Hospital Uppsala, Sweden
| | | | - Gunnar Tómasson
- Centre of Public Health Sciences, Faculty of Medicine, University of Iceland, Reykjavík, Iceland
| | - Unnur Anna Valdimarsdóttir
- Centre of Public Health Sciences, Faculty of Medicine, University of Iceland, Reykjavík, Iceland
- Department of Epidemiology, Harvard School of Public Health, Boston, MA, USA
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Friedrichsdorf SJ, Giordano J, Desai Dakoji K, Warmuth A, Daughtry C, Schulz CA. Chronic Pain in Children and Adolescents: Diagnosis and Treatment of Primary Pain Disorders in Head, Abdomen, Muscles and Joints. Children (Basel) 2016; 3:children3040042. [PMID: 27973405 PMCID: PMC5184817 DOI: 10.3390/children3040042] [Citation(s) in RCA: 65] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/31/2016] [Revised: 11/26/2016] [Accepted: 12/01/2016] [Indexed: 12/12/2022]
Abstract
Primary pain disorders (formerly “functional pain syndromes”) are common, under-diagnosed and under-treated in children and teenagers. This manuscript reviews key aspects which support understanding the development of pediatric chronic pain, points to the current pediatric chronic pain terminology, addresses effective treatment strategies, and discusses the evidence-based use of pharmacology. Common symptoms of an underlying pain vulnerability present in the three most common chronic pain disorders in pediatrics: primary headaches, centrally mediated abdominal pain syndromes, and/or chronic/recurrent musculoskeletal and joint pain. A significant number of children with repeated acute nociceptive pain episodes develop chronic pain in addition to or as a result of their underlying medical condition “chronic-on-acute pain.” We provide description of the structure and process of our interdisciplinary, rehabilitative pain clinic in Minneapolis, Minnesota, USA with accompanying data in the treatment of chronic pain symptoms that persist beyond the expected time of healing. An interdisciplinary approach combining (1) rehabilitation; (2) integrative medicine/active mind-body techniques; (3) psychology; and (4) normalizing daily school attendance, sports, social life and sleep will be presented. As a result of restored function, pain improves and commonly resolves. Opioids are not indicated for primary pain disorders, and other medications, with few exceptions, are usually not first-line therapy.
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Affiliation(s)
- Stefan J Friedrichsdorf
- Children's Hospitals and Clinics of Minnesota, Minneapolis, MN 55404, USA.
- Department of Pediatrics, University of Minnesota Medical School, Minneapolis, MN 55455, USA.
| | - James Giordano
- Georgetown University Medical Center, Washington, DC 20057, USA.
| | | | - Andrew Warmuth
- Children's Hospitals and Clinics of Minnesota, Minneapolis, MN 55404, USA.
| | - Cyndee Daughtry
- Children's Hospitals and Clinics of Minnesota, Minneapolis, MN 55404, USA.
| | - Craig A Schulz
- Children's Hospitals and Clinics of Minnesota, Minneapolis, MN 55404, USA.
- Center for Spirituality & Healing, University of Minnesota, Minneapolis, MN 55455, USA.
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McCluskey A, Lovarini M, Bennett S, McKenna K, Tooth L, Hoffmann T. What Evidence Exists for Work-Related Injury Prevention and Management? Analysis of an Occupational Therapy Evidence Database (OTseeker). Br J Occup Ther 2016. [DOI: 10.1177/030802260506801003] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
This study aimed to summarise the quantity and quality of research contained in an online evidence database (OTseeker) in one practice area, work-related injury prevention and management, to highlight the available evidence. In May 2004, the systematic reviews and randomised controlled trials (RCTs) contained in OTseeker were analysed. The number and proportion of systematic reviews and RCTs and the number and proportion of RCTs meeting each of the 10 criteria on the PEDro scale (partitioned) were calculated and the topics and conclusions of the systematic reviews were summarised. Of the 2330 records contained in OTseeker, 346 (14.8%) related to work-related injury prevention and management (86 systematic reviews and 260 RCTs). Of the 260 RCTs, the majority (n = 140, 53.8%) scored between 3/8 and 5/8 for internal validity on the PEDro scale (partitioned); a few scored 6/8 or more (n = 13, 5.0%). The majority of the RCTs scored 2/2 for the reporting of results (n = 217, 83.5%). Evidence was identified, mostly for the treatment of low back pain, to support the use of multidisciplinary biopsychosocial rehabilitation including workplace visits, back schools, workplace exercise, and advice to stay active and/or return to normal activities. OTseeker contains a substantial body of research on the effectiveness of work-related injury prevention and management, although this research is of varying methodological quality.
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Madabushi R, Agarwal A, Tewari S, Gautam SKS, Khuba S. Depression masquerading as chest pain in a patient with Wolff Parkinson White syndrome. Korean J Pain 2016; 29:262-265. [PMID: 27738505 PMCID: PMC5061643 DOI: 10.3344/kjp.2016.29.4.262] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2015] [Revised: 04/24/2016] [Accepted: 05/02/2016] [Indexed: 11/10/2022] Open
Abstract
Wolff Parkinson White (WPW) syndrome is a condition in which there is an aberrant conduction pathway between the atria and ventricles, resulting in tachycardia. A 42-year-old patient, who was treated for WPW syndrome previously, presented with chronic somatic pain. With her cardiac condition in mind, she was thoroughly worked up for a recurrence of disease. As part of routine screening of all patients at our pain clinic, she was found to have severe depression as per the Patient Health Questionnaire–9 (PHQ–9) criteria. After ruling out sinister causes, she was treated for depression using oral Duloxetine and counselling. This led to resolution of symptoms, and improved her mood and functional capability. This case highlights the use of psychological screening tools and diligent examination in scenarios as confusing as the one presented here. Addressing the psychological aspects of pain and adopting a holistic approach are as important as treatment of the primary pathology.
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Affiliation(s)
- Rajashree Madabushi
- Department of Anaesthesiology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, India
| | - Anil Agarwal
- Department of Anaesthesiology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, India
| | - Saipriya Tewari
- Department of Anaesthesiology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, India
| | - Sujeet K S Gautam
- Department of Anaesthesiology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, India
| | - Sandeep Khuba
- Department of Anaesthesiology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, India
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Taylor SJC, Carnes D, Homer K, Pincus T, Kahan BC, Hounsome N, Eldridge S, Spencer A, Diaz-Ordaz K, Rahman A, Mars TS, Foell J, Griffiths CJ, Underwood MR. Improving the self-management of chronic pain: COping with persistent Pain, Effectiveness Research in Self-management (COPERS). Programme Grants Appl Res 2016. [DOI: 10.3310/pgfar04140] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
BackgroundChronic musculoskeletal pain is a common problem that is difficult to treat. Self-management support interventions may help people to manage this condition better; however, there is limited evidence showing that they improve clinical outcomes. Our overarching research question was ‘Does a self-management support programme improve outcomes for people living with chronic musculoskeletal pain?’.AimTo develop, evaluate and test the clinical effectiveness and cost-effectiveness of a theoretically grounded self-management support intervention for people living with chronic musculoskeletal pain.MethodsIn phase 1 we carried out two systematic reviews to synthesise the evidence base for self-management course content and delivery styles likely to help those with chronic pain. We also considered the psychological theories that might underpin behaviour change and pain management principles. Informed by these data we developed the Coping with persistent Pain, Evaluation Research in Self-management (COPERS) intervention, a group intervention delivered over 3 days with a top-up session after 2 weeks. It was led by two trained facilitators: a health-care professional and a layperson with experience of chronic pain. To ensure that we measured the most appropriate outcomes we reviewed the literature on potential outcome domains and measures and consulted widely with patients, tutors and experts. In a feasibility study we demonstrated that we could deliver the COPERS intervention in English and, to increase the generalisability of our findings, also in Sylheti for the Bangladeshi community. In phase 2 we ran a randomised controlled trial to test the clinical effectiveness and cost-effectiveness of adding the COPERS intervention to a best usual care package (usual care plus a relaxation CD and a pain toolkit leaflet). We recruited adults with chronic musculoskeletal pain largely from primary care and musculoskeletal physiotherapy services in two localities: east London and Coventry/Warwickshire. We collected follow-up data at 12 weeks (self-efficacy only) and 6 and 12 months. Our primary outcome was pain-related disability (Chronic Pain Grade disability subscale) at 12 months. We also measured costs, health utility (European Quality of Life-5 Dimensions), anxiety, depression [Hospital Anxiety and Depression Scale (HADS)], coping, pain acceptance and social integration. Data on the use of NHS services by participants were extracted from NHS electronic records.ResultsWe recruited 703 participants with a mean age of 60 years (range 19–94 years); 81% were white and 67% were female. Depression and anxiety symptoms were common, with mean HADS depression and anxiety scores of 7.4 [standard deviation (SD) 4.1] and 9.2 (SD 4.6), respectively. Intervention participants received 85% of the course content. At 12 months there was no difference between treatment groups in our primary outcome of pain-related disability [difference –1.0 intervention vs. control, 95% confidence interval (CI) –4.9 to 3.0]. However, self-efficacy, anxiety, depression, pain acceptance and social integration all improved more in the intervention group at 6 months. At 1 year these differences remained for depression (–0.7, 95% CI –1.2 to –0.2) and social integration (0.8, 95% CI, 0.4 to 1.2). The COPERS intervention had a high probability (87%) of being cost-effective compared with usual care at a threshold of £30,000 per quality-adjusted life-year.ConclusionsAlthough the COPERS intervention did not affect our primary outcome of pain-related disability, it improved psychological well-being and is likely to be cost-effective according to current National Institute for Health and Care Excellence criteria. The COPERS intervention could be used as a substitute for less well-evidenced (and more expensive) pain self-management programmes. Effective interventions to improve hard outcomes in chronic pain patients, such as disability, are still needed.Trial registrationCurrent Controlled Trials ISRCTN22714229.FundingThe project was funded by the National Institute for Health Research Programme Grants for Applied Research programme and will be published in full inProgramme Grants for Applied Research; Vol. 4, No. 14. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Stephanie JC Taylor
- Centre for Primary Care and Public Health, Blizard Institute, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Dawn Carnes
- Centre for Primary Care and Public Health, Blizard Institute, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Kate Homer
- Centre for Primary Care and Public Health, Blizard Institute, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Tamar Pincus
- Department of Psychology, Royal Holloway University of London, Egham, UK
| | - Brennan C Kahan
- Centre for Primary Care and Public Health, Blizard Institute, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Natalia Hounsome
- Centre for Primary Care and Public Health, Blizard Institute, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Sandra Eldridge
- Centre for Primary Care and Public Health, Blizard Institute, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Anne Spencer
- Exeter Medical School, University of Exeter, Exeter, UK
| | - Karla Diaz-Ordaz
- Department of Health Services Research and Policy, London School of Hygiene & Tropical Medicine, London, UK
| | - Anisur Rahman
- Department of Rheumatology, University College Hospital, University College London, London, UK
| | - Tom S Mars
- Centre for Primary Care and Public Health, Blizard Institute, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Jens Foell
- Centre for Primary Care and Public Health, Blizard Institute, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Chris J Griffiths
- Centre for Primary Care and Public Health, Blizard Institute, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Martin R Underwood
- Clinical Trials Unit, Warwick Medical School, University of Warwick, Coventry, UK
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Abstract
Failed back surgery syndrome (FBSS) is a frequent complication (15-40 %) of lumbar disc surgery and is rarely successfully treated by surgery with the exception of a re-prolapse associated with radicular pain. Multimodal pain treatment, however, is indicated by a lack of pathoanatomical correlates, unclear cause and psychosocial risk factors.This review describes a standardized non-operative treatment starting with broad interdisciplinary clarification by medical, psychological and physiotherapeutic means (assessment).If the conditions for multimodal pain therapy are met, the OPS 8‑918-procedure can be applied to avoid chronic developing pain. In doing so, the already issued quality standards and guidelines for documentation should be respected.
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García García JA, Hernández-Puiggròs P, Tesedo Nieto J, Acín Lázaro MP, Carrera González A, Soler MJ, Maldonado Vega S. Patient Satisfaction with Spanish Pain Centers: Observational Study with More than 3,000 Patients. Pain Res Treat 2016; 2016:7829585. [PMID: 27516902 DOI: 10.1155/2016/7829585] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/05/2016] [Accepted: 06/19/2016] [Indexed: 11/18/2022]
Abstract
Chronic pain is a serious problem in Spain. This multicenter, epidemiological 3-month follow-up study investigates pain management efficacy in Spanish centers using patient satisfaction criteria. 3,414 eligible adult patients (65,6% female) with moderate to severe chronic pain from 146 pain centers were included. Patient satisfaction was assessed based onto question 18 of Spanish healthcare barometer-CSI. Pain evolution (Brief Pain Inventory-Short Form (BPI-SF) and visual analog scale (VAS)), quality of life/EuroQol-5, and pain control expectations fulfillment were also assessed. Mean age was 61.3 years. 64.4% of participating centers employed multidisciplinary pain management approach. After 3 months, mean patient satisfaction was 7.8 (1-10) on the CIS barometer. Medical staff received the highest scores, whereas waiting for tests, appointment request to appointment date time, and waiting times at the center the lowest. Mean pain decreased from 7.4 to 4.0; BPI-SF intensity decreased from 6.5 to 3.8; pain control expectations were met in 78.7% of patients; EuroQoL-5D utility index increased from 0.37 to 0.62, p < 0.001, and health status (VAS) from 40.6 to 61.9, p < 0.001. Chronic pain patients (90%) are satisfied with Spanish centers care; 80% had their pain control expectations met. Quality of life improved remarkably: 71% felt moderately to significantly better. However, waiting times need improvement.
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Budhrani-Shani P, Berry DL, Arcari P, Langevin H, Wayne PM. Mind-Body Exercises for Nurses with Chronic Low Back Pain: An Evidence-Based Review. Nurs Res Pract 2016; 2016:9018036. [PMID: 27446610 PMCID: PMC4947504 DOI: 10.1155/2016/9018036] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2016] [Accepted: 06/05/2016] [Indexed: 11/29/2022] Open
Abstract
Background. Chronic low back pain (CLBP) among nurses is a growing health concern. The multimodal nature of mind-body exercises has potential to impact physiological and psychological processes associated with chronic pain, affording possible advantages over conventional unimodal therapies. This paper summarizes the prevalence of and risk factors for CLBP among nurses, reviews the effectiveness in treating pain and disability of mind-body exercises (yoga and tai chi) for CLBP among the general and nursing population, and describes implications. Methods. Articles, published during or prior to 2015, were systematically identified through the PubMed/MEDLINE, Web of Science, and ScienceDirect databases using the following search terms: nurses, mind-body, integrative, biopsychosocial, yoga, tai chi, back pain, and/or risk factors. Results. Prevalence estimates of CLBP among nurses ranged from 50% to 80%. Associated risk factors for CLBP included lifestyle and physical, psychological, psychosocial, and occupational factors. No published studies were identified that evaluated yoga or tai chi for nurses with CLBP. Studies in the general population suggested that these interventions are effective in reducing pain and disability and may improve factors/processes predictive of CLBP. Conclusion. This review suggests that evaluating the impact of multimodal interventions such as yoga and tai chi for nurses with CLBP warrants investigation.
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Affiliation(s)
- Pinky Budhrani-Shani
- Texas Woman's University, Nelda C. Stark College of Nursing, Houston, TX 77030, USA
- Phyllis F. Cantor Center for Research in Nursing & Patient Care Services, Dana-Farber/Harvard Cancer Center, Boston, MA 02215, USA
| | - Donna L. Berry
- Phyllis F. Cantor Center for Research in Nursing & Patient Care Services, Dana-Farber/Harvard Cancer Center, Boston, MA 02215, USA
| | | | - Helene Langevin
- Osher Center for Integrative Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115, USA
| | - Peter M. Wayne
- Osher Center for Integrative Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115, USA
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Neue DRG-Logik sichert die wirtschaftliche Zukunftsfähigkeit der länger dauernden therapieintensiven vollstationären multimodalen Schmerztherapie. Schmerz 2016; 30:118-122. [DOI: 10.1007/s00482-016-0103-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Pieber K, Herceg M, Csapo R, Wiesinger G, Quittan M, Crevenna R, Mittermaier C. Effects of a multidisciplinary programme on postural stability in patients with chronic recurrent low back pain: preliminary findings. Eur Spine J 2015; 25:1219-25. [PMID: 26493702 DOI: 10.1007/s00586-015-4293-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/30/2015] [Revised: 10/13/2015] [Accepted: 10/13/2015] [Indexed: 11/28/2022]
Abstract
PURPOSE This longitudinal study investigated the effects of a multidisciplinary rehabilitation programme on postural stability in patients with low back pain. While the consequences of such rehabilitation programme have been described for pain, mobility, strength, and functional disability, the effects on postural stability have not been examined so far. METHODS Thirty-four patients suffering from chronic low back pain were included to participate in a multidisciplinary rehabilitation programme. We assessed postural stability, pain, strength of the lumbar extensor muscles, and functional disability. The examinations were performed before the intervention, after 20 training sessions ("half-way point"), and at the end of the rehabilitation programme. RESULTS All outcome measures improved significantly from baseline to the first follow-up evaluation and remained constant until completion of the rehabilitation programme. CONCLUSIONS A multidisciplinary outpatient rehabilitation programme may improve postural stability, muscle strength, pain, and functional disability in patients with chronic low back pain.
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Affiliation(s)
- Karin Pieber
- Department of Physical Medicine and Rehabilitation, Medical University of Vienna, General Hospital of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria.
| | - Malvina Herceg
- Department of Physical Medicine and Rehabilitation, Medical University of Vienna, General Hospital of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
| | - Robert Csapo
- Institute for Sport Science, University of Innsbruck, Innsbruck, Austria
| | - Günther Wiesinger
- Department of Physical Medicine and Rehabilitation, University Hospital Salzburg, Paracelsus Medical University, Salzburg, Austria
| | - Michael Quittan
- Landsteiner Institute of Remobilisation and Functional Health, Vienna, Austria
| | - Richard Crevenna
- Department of Physical Medicine and Rehabilitation, Medical University of Vienna, General Hospital of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
| | - Christian Mittermaier
- Department of Physical Medicine and Rehabilitation, General Hospital Linz, Linz, Austria
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37
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Mattenklodt P, Leonhardt C. [Psychological assessment and psychotherapy for chronic pain in the elderly]. Schmerz 2015; 29:349-61. [PMID: 26024645 DOI: 10.1007/s00482-015-0007-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Systematic reviews of psychosocial assessment and effectiveness of psychotherapy for chronic pain syndromes in older patients are rare. However, it is of particular importance to consider the psychosocial aspects of elderly people with chronic pain. This narrative review describes recommended German-language assessments of the psychosocial dimensions of pain and summarizes existing studies of psychological therapy approaches for chronic pain in old age. Effective psychometric instruments are available for the assessment of cognitive function, pain-specific attitudes, depression, fear of falling, interpersonal processes and social activities, pain management, pain acceptance, disability, psychological well-being, and quality of life. Further experience with the use of these instruments with cognitively impaired or geriatric patients is required. The efficacy of age-adapted cognitive behavioral therapy and multimodal therapy for older patients has been documented. However, there is often a lack of supporting documentation about important result parameters (e.g., quality of life, functioning in everyday life, or pain acceptance). Overall, chronic pain in elderly people requires a biopsychosocial-spiritual model of pain. More attention should be given in research and daily practice to religiosity/spirituality as a possible means of coping, while mindfulness- and acceptance-based therapies should be further explored.
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Semrau J, Hentschke C, Buchmann J, Meng K, Vogel H, Faller H, Bork H, Pfeifer K. Long-term effects of interprofessional biopsychosocial rehabilitation for adults with chronic non-specific low back pain: a multicentre, quasi-experimental study. PLoS One 2015; 10:e0118609. [PMID: 25768735 PMCID: PMC4359119 DOI: 10.1371/journal.pone.0118609] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2014] [Accepted: 01/19/2015] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Improvement of the long-term effectiveness of multidisciplinary ortho-paedic rehabilitation (MOR) in the management of chronic non-specific low back pain (CLBP) remains a central issue for health care in Germany. We developed an interprofessional and interdisciplinary, biopsychosocial rehabilitation concept named "PASTOR" to promote self-management in adults with CLBP and compared its effectiveness with the current model of MOR. METHODS A multicentre quasi-experimental study with three measurement time points was implemented. 680 adults aged 18 to 65 with CLBP were assed for eligibil-ity in three inpatient rehabilitation centres in Germany. At first the effects of the MOR, with a total extent of 48 hours (control group), were assessed. Thereafter, PASTOR was implemented and evaluated in the same centres (intervention group). It consisted of six interprofessional modules, which were provided on 12 days in fixed groups, with a total extent of 48 hours. Participants were assessed with self-report measures at baseline, discharge, and 12 months for functional ability (primary outcome) using the Hannover Functional Ability Questionnaire (FFbH-R) and vari-ous secondary outcomes (e.g. pain, health status, physical activity, pain coping, pain-related cognitions). RESULTS In total 536 participants were consecutively assigned to PASTOR (n=266) or MOR (n=270). At 12 months, complete data of 368 participants was available. The adjusted between-group difference in the FFbH-R at 12 months was 6.58 (95% CI 3.38 to 9.78) using complete data and 3.56 (95% CI 0.45 to 6.67) using available da-ta, corresponding to significant small-to-medium effect sizes of d=0.42 (p<0.001) and d=0.10 (p=0.025) in favour of PASTOR. Further improvements in secondary out-comes were also observed in favour of PASTOR. CONCLUSION The interprofessional and interdisciplinary, biopsychosocial rehabilita-tion program PASTOR shows some improvements of the long-term effectiveness of inpatient rehabilitation in the management of adults with CLBP. Further insights into mechanisms of action of complex intervention programs are required. TRIAL REGISTRATION ClinicalTrials.gov NCT02056951.
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Affiliation(s)
- Jana Semrau
- Friedrich-Alexander-University Erlangen-Nürnberg, Institute of Sport Science and Sport, Erlangen, Germany
| | - Christian Hentschke
- Friedrich-Alexander-University Erlangen-Nürnberg, Institute of Sport Science and Sport, Erlangen, Germany
| | - Jana Buchmann
- University of Würzburg, Department of Medical Psychology, Medical Sociology, and Rehabilitation Sciences, Würzburg, Germany
| | - Karin Meng
- University of Würzburg, Department of Medical Psychology, Medical Sociology, and Rehabilitation Sciences, Würzburg, Germany
| | - Heiner Vogel
- University of Würzburg, Department of Medical Psychology, Medical Sociology, and Rehabilitation Sciences, Würzburg, Germany
| | - Hermann Faller
- University of Würzburg, Department of Medical Psychology, Medical Sociology, and Rehabilitation Sciences, Würzburg, Germany
| | - Hartmut Bork
- Reha-Zentrum am Sankt Josef-Stift, Sendenhorst, Germany
| | - Klaus Pfeifer
- Friedrich-Alexander-University Erlangen-Nürnberg, Institute of Sport Science and Sport, Erlangen, Germany
- * E-mail:
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Kamper SJ, Apeldoorn AT, Chiarotto A, Smeets RJEM, Ostelo RWJG, Guzman J, van Tulder MW. Multidisciplinary biopsychosocial rehabilitation for chronic low back pain: Cochrane systematic review and meta-analysis. BMJ 2015; 350:h444. [PMID: 25694111 PMCID: PMC4353283 DOI: 10.1136/bmj.h444] [Citation(s) in RCA: 549] [Impact Index Per Article: 61.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
OBJECTIVE To assess the long term effects of multidisciplinary biopsychosocial rehabilitation for patients with chronic low back pain. DESIGN Systematic review and random effects meta-analysis of randomised controlled trials. DATA SOURCES Electronic searches of Cochrane Back Review Group Trials Register, CENTRAL, Medline, Embase, PsycINFO, and CINAHL databases up to February 2014, supplemented by hand searching of reference lists and forward citation tracking of included trials. STUDY SELECTION CRITERIA Trials published in full; participants with low back pain for more than three months; multidisciplinary rehabilitation involved a physical component and one or both of a psychological component or a social or work targeted component; multidisciplinary rehabilitation was delivered by healthcare professionals from at least two different professional backgrounds; multidisciplinary rehabilitation was compared with a non- multidisciplinary intervention. RESULTS Forty one trials included a total of 6858 participants with a mean duration of pain of more than one year who often had failed previous treatment. Sixteen trials provided moderate quality evidence that multidisciplinary rehabilitation decreased pain (standardised mean difference 0.21, 95% confidence interval 0.04 to 0.37; equivalent to 0.5 points in a 10 point pain scale) and disability (0.23, 0.06 to 0.40; equivalent to 1.5 points in a 24 point Roland-Morris index) compared with usual care. Nineteen trials provided low quality evidence that multidisciplinary rehabilitation decreased pain (standardised mean difference 0.51, -0.01 to 1.04) and disability (0.68, 0.16 to 1.19) compared with physical treatments, but significant statistical heterogeneity across trials was present. Eight trials provided moderate quality evidence that multidisciplinary rehabilitation improves the odds of being at work one year after intervention (odds ratio 1.87, 95% confidence interval 1.39 to 2.53) compared with physical treatments. Seven trials provided moderate quality evidence that multidisciplinary rehabilitation does not improve the odds of being at work (odds ratio 1.04, 0.73 to 1.47) compared with usual care. Two trials that compared multidisciplinary rehabilitation with surgery found little difference in outcomes and an increased risk of adverse events with surgery. CONCLUSIONS Multidisciplinary biopsychosocial rehabilitation interventions were more effective than usual care (moderate quality evidence) and physical treatments (low quality evidence) in decreasing pain and disability in people with chronic low back pain. For work outcomes, multidisciplinary rehabilitation seems to be more effective than physical treatment but not more effective than usual care.
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Affiliation(s)
- Steven J Kamper
- Musculoskeletal Division, George Institute, University of Sydney, Sydney 2050, NSW, Australia Department of Epidemiology and Biostatistics and the EMGO+ Institute, VU University Medical Centre, Amsterdam 1081BT, Netherlands
| | - A T Apeldoorn
- Department of Epidemiology and Biostatistics and the EMGO+ Institute, VU University Medical Centre, Amsterdam 1081BT, Netherlands
| | - A Chiarotto
- Department of Epidemiology and Biostatistics and the EMGO+ Institute, VU University Medical Centre, Amsterdam 1081BT, Netherlands
| | - R J E M Smeets
- Rehabilitation Medicine Department, Maastricht University Medical Centre, Maastricht 6200MD, Netherlands
| | - R W J G Ostelo
- Department of Epidemiology and Biostatistics and the EMGO+ Institute, VU University Medical Centre, Amsterdam 1081BT, Netherlands Department of Health Sciences, Faculty of Earth and Life Sciences, VU University, Amsterdam 1081HV, Netherlands
| | - J Guzman
- University of British Columbia, Vancouver, Canada V6T 1Z3
| | - M W van Tulder
- Department of Health Sciences, Faculty of Earth and Life Sciences, VU University, Amsterdam 1081HV, Netherlands
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Verkerk K, Luijsterburg PAJ, Heymans MW, Ronchetti I, Pool-Goudzwaard AL, Miedema HS, Koes BW. Prognosis and course of pain in patients with chronic non-specific low back pain: A 1-year follow-up cohort study. Eur J Pain 2015; 19:1101-10. [PMID: 25565501 DOI: 10.1002/ejp.633] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/04/2014] [Indexed: 11/10/2022]
Abstract
BACKGROUND It remains unclear to what extent patients recover from chronic non-specific low back pain (NSLBP). The objective of this study was to determine (1) the course of chronic NSLBP in tertiary care and (2) which factors predicted 5- and 12-month outcomes. METHODS This prospective study includes 1760 chronic NSLBP patients from a rehabilitation clinic (mean age 40.1 years, SD 10.6). After baseline measurement, patients followed a 2-month multidisciplinary therapy programme; evaluation took place at 2, 5 and 12 months post baseline. Recovery was defined as (1) relative recovery [30% improvement on the pain, visual analogue scale (VAS) compared with baseline] and (2) absolute recovery (VAS pain ≤ 10 mm). The multivariate logistic regression analysis included 23 baseline characteristics. RESULTS Patient-reported intensity of back pain decreased from 55.5 (SD 23.0) at baseline to 37.0 (SD 23.8), 35.3 (SD 26.1) and 32.3 (SD 26.9) at 2-, 5- and 12-month follow-up, respectively. Younger age, back pain at baseline, no psychological/physical dysfunction (Symptom Check List-90, item 9), and higher baseline scores on the physical component scale and mental component scale of quality of life (Short Form-36) were positively associated with recovery at 5 and 12 months. At 5-month follow-up, higher work participation at baseline was also a prognostic factor for both definitions of recovery. At 12-month follow-up, having co-morbidity was predictive for both definitions. CONCLUSION The results of this study indicate that in chronic NSLBP patients, bio-psychosocial prognostic factors may be important for clinicians when predicting recovery in back pain intensity during a 1-year period.
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Affiliation(s)
- K Verkerk
- Rotterdam University of Applied Sciences, The Netherlands.,Spine & Joint Centre, Rotterdam, The Netherlands.,Department of General Practice, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | - P A J Luijsterburg
- Department of General Practice, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | - M W Heymans
- EMGO Institute for Health and Care Research, VU University Medical Centre, Amsterdam, The Netherlands.,Department of Methodology and Applied Biostatistics, Institute for Health Sciences, VU University, Amsterdam, The Netherlands.,Department of Clinical Epidemiology and Biostatistics, VU University Medical Centre, Amsterdam, The Netherlands
| | - I Ronchetti
- Spine & Joint Centre, Rotterdam, The Netherlands
| | - A L Pool-Goudzwaard
- Department of Neuroscience, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | - H S Miedema
- Rotterdam University of Applied Sciences, The Netherlands
| | - B W Koes
- Department of General Practice, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
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Abstract
Chronic pain continues to pose substantial and growing challenges for patients, caregivers, health care professionals, and health care systems. By the time a patient with severe refractory pain sees a pain specialist for evaluation and management, that patient has likely tried and failed several nonpharmacologic and pharmacologic approaches to pain treatment. Although relegated to one of the interventions of "last resort", intrathecal drug delivery can be useful for improving pain control, optimizing patient functionality, and minimizing the use of systemic pain medications in appropriately selected patients. Due to its clinical and logistical requirements, however, intrathecal drug delivery may fit poorly into the classic pain clinic/interventional model and may be perceived as a "critical mass" intervention that is feasible only for large practices that have specialized staff and appropriate office resources. Potentially, intrathecal drug delivery may be more readily adopted into larger practices that can commit the necessary staff and resources to support patients' needs through the trialing, initiation, monitoring, maintenance, and troubleshooting phases of this therapy. Currently, two agents - morphine and ziconotide - are approved by the United States Food and Drug Administration for long-term intrathecal delivery. The efficacy and safety profiles of morphine have been assessed in long-term, open-label, and retrospective studies of >400 patients with chronic cancer and noncancer pain types. The efficacy and safety profiles of ziconotide have been assessed in three double-blind, placebo-controlled trials of 457 patients, and safety has been assessed in 1,254 patients overall, with severe chronic cancer, noncancer, and acquired immunodeficiency syndrome pain types. Both agents are highlighted as first-line intrathecal therapy for the management of neuropathic or nociceptive pain. The purpose of this review is to discuss practical considerations for intrathecal drug delivery, delineate criteria for the identification and selection of candidates for intrathecal drug delivery, and consider which agent may be more appropriate for individual patients.
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Affiliation(s)
- Michael Saulino
- MossRehab, Elkins Park, PA, USA ; Department of Rehabilitation Medicine, Jefferson Medical College, Philadelphia, PA, USA
| | - Philip S Kim
- Helen F Graham Cancer Center, Christiana Care Health System, Newark, DE, USA ; Center for Interventional Pain Spine, LLC., Bryn Mawr, PA, USA
| | - Erik Shaw
- Shepherd Pain Institute, Shepherd Center, Atlanta, GA, USA
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Perreault K, Dionne CE, Rossignol M, Poitras S, Morin D. Physiotherapy practice in the private sector: organizational characteristics and models. BMC Health Serv Res 2014; 14:362. [PMID: 25168160 PMCID: PMC4161767 DOI: 10.1186/1472-6963-14-362] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2013] [Accepted: 08/20/2014] [Indexed: 11/29/2022] Open
Abstract
Background Even if a large proportion of physiotherapists work in the private sector worldwide, very little is known of the organizations within which they practice. Such knowledge is important to help understand contexts of practice and how they influence the quality of services and patient outcomes. The purpose of this study was to: 1) describe characteristics of organizations where physiotherapists practice in the private sector, and 2) explore the existence of a taxonomy of organizational models. Methods This was a cross-sectional quantitative survey of 236 randomly-selected physiotherapists. Participants completed a purpose-designed questionnaire online or by telephone, covering organizational vision, resources, structures and practices. Organizational characteristics were analyzed descriptively, while organizational models were identified by multiple correspondence analyses. Results Most organizations were for-profit (93.2%), located in urban areas (91.5%), and within buildings containing multiple businesses/organizations (76.7%). The majority included multiple providers (89.8%) from diverse professions, mainly physiotherapy assistants (68.7%), massage therapists (67.3%) and osteopaths (50.2%). Four organizational models were identified: 1) solo practice, 2) middle-scale multiprovider, 3) large-scale multiprovider and 4) mixed. Conclusions The results of this study provide a detailed description of the organizations where physiotherapists practice, and highlight the importance of human resources in differentiating organizational models. Further research examining the influences of these organizational characteristics and models on outcomes such as physiotherapists’ professional practices and patient outcomes are needed.
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Affiliation(s)
| | - Clermont E Dionne
- Centre for Interdisciplinary Research in Rehabilitation and Social Integration (CIRRIS), Institut de réadaptation en déficience physique de Québec, Québec City, Canada.
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Perreault K, Dionne CE, Rossignol M, Morin D. Interprofessional practices of physiotherapists working with adults with low back pain in Québec's private sector: results of a qualitative study. BMC Musculoskelet Disord 2014; 15:160. [PMID: 24884757 PMCID: PMC4032868 DOI: 10.1186/1471-2474-15-160] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2013] [Accepted: 05/06/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Collaboration and interprofessional practices are highly valued in health systems, because they are thought to improve outcomes of care for persons with complex health problems, such as low back pain. Physiotherapists, like all health providers, are encouraged to take part in interprofessional practices. However, little is known about these practices, especially for private sector physiotherapists. This study aimed to: 1) explore how physiotherapists working in the private sector with adults with low back pain describe their interprofessional practices, 2) identify factors that influence their interprofessional practices, and 3) identify their perceived effects. METHODS Participants were 13 physiotherapists, 10 women/3 men, having between 3 and 21 years of professional experience. For this descriptive qualitative study, we used face-to-face semi-structured interviews and conducted content analysis encompassing data coding and thematic regrouping. RESULTS Physiotherapists described interprofessional practices heterogeneously, including numerous processes such as sharing information and referring. Factors that influenced physiotherapists' interprofessional practices were related to patients, providers, organizations, and wider systems (e.g. professional system). Physiotherapists mostly viewed positive effects of interprofessional practices, including elements such as gaining new knowledge as a provider and being valued in one's own role, as well as improvements in overall treatment and outcome. CONCLUSIONS This qualitative study offers new insights into the interprofessional practices of physiotherapists working with adults with low back pain, as perceived by the physiotherapists' themselves. Based on the results, the development of strategies aiming to increase interprofessionalism in the management of low back pain would most likely require taking into consideration factors associated with patients, providers, the organizations within which they work, and the wider systems.
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Affiliation(s)
| | - Clermont E Dionne
- Centre for Interdisciplinary Research in Rehabilitation and Social Integration, Institut de réadaptation en déficience physique de Québec, Québec City, Canada.
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44
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Finger ME, Selb M, De Bie R, Escorpizo R. Using the International Classification of Functioning, Disability and Health in Physiotherapy in Multidisciplinary Vocational Rehabilitation: A Case Study of Low Back Pain. Physiother Res Int 2014; 20:231-41. [DOI: 10.1002/pri.1587] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2013] [Revised: 08/30/2013] [Accepted: 02/13/2014] [Indexed: 12/19/2022]
Affiliation(s)
- Monika E. Finger
- Swiss Paraplegic Research (SPF); Nottwil Switzerland
- ICF Research Branch in cooperation with the WHO Collaborating Centre for the Family of International Classifications in Germany (at DIMDI); Nottwil Switzerland
- CAPHRI Research School; Maastricht University; Maastricht The Netherlands
| | - Melissa Selb
- Swiss Paraplegic Research (SPF); Nottwil Switzerland
- ICF Research Branch in cooperation with the WHO Collaborating Centre for the Family of International Classifications in Germany (at DIMDI); Nottwil Switzerland
| | - Robert De Bie
- CAPHRI Research School; Maastricht University; Maastricht The Netherlands
- Department of Epidemiology and Institute for Education; Maastricht University; Maastricht The Netherlands
| | - Reuben Escorpizo
- Swiss Paraplegic Research (SPF); Nottwil Switzerland
- ICF Research Branch in cooperation with the WHO Collaborating Centre for the Family of International Classifications in Germany (at DIMDI); Nottwil Switzerland
- Department of Physical Therapy; Louisiana State University Health Sciences Center; New Orleans LA USA
- Department of Health Sciences and Health Policy; University of Lucerne; Lucerne Switzerland
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45
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Abstract
Cross-sectoral clinical pathways for chronic pain patients in standard and routine care are a major challenge for the German healthcare system. The Algesiologikum group has developed such clinical pathways including an essential infrastructure. Cooperation partners of the Algesiologikum group are two outpatient medical care units, one neurosurgery practice and four hospitals. In the outpatient sector as well as in the inpatient sector the Algesiologikum group provides a multidisciplinary team caring for chronic pain patients. The range of treatment in the hospitals includes multimodal, invasive and surgical pain therapy. The present report illustrates possibilities and frontiers of the Algesiologikum concept based on all patients treated since 2009.
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Affiliation(s)
- A-M Schneider
- Algesiologikum - Zentren für Schmerzmedizin, Karlstrasse 96, Munich, Germany.
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46
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Sullivan MJL, Simon G. A telephonic intervention for promoting occupational re-integration in work-disabled individuals with musculoskeletal pain. Transl Behav Med 2013; 2:149-58. [PMID: 24073107 DOI: 10.1007/s13142-012-0119-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022] Open
Abstract
The purpose of the present research was to examine the feasibility of a telephonic occupational rehabilitation program. A sample of 23 individuals with chronic musculoskeletal pain was enrolled in the telephonic version of the Progressive Goal Attainment Program (PGAP-Tel). The PGAP-Tel is a risk-targeted intervention designed to reduce pain-related disability consequent to musculoskeletal injury. Treatment outcomes of PGAP-Tel were compared to a group of individuals with chronic musculoskeletal pain, who participated in the face-to-face format of the PGAP. Results showed that PGAP-Tel was acceptable to the majority of participants (76%) to whom it was offered. There were indications that engagement and adherence issues were more problematic in PGAP-Tel than in the face-to-face intervention. Both groups showed comparable reductions in pain, depression, fear of symptom exacerbation, and self-reported disability. Participants in the face-to-face intervention showed greater reduction in catastrophic thinking than participants in PGAP-Tel. Finally, 26% of participants in PGAP-Tel had resumed some form of employment at treatment termination compared to 56% of the participants in the face-to-face intervention. Given the low cost of the PGAP-Tel intervention and the accessibility advantages of a telephonic delivery, this type of intervention might be an important resource for targeting occupational disability in rural or remote communities when face-to-face services are not available.
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Nevedal DC, Wang C, Oberleitner L, Schwartz S, Williams AM. Effects of an individually tailored Web-based chronic pain management program on pain severity, psychological health, and functioning. J Med Internet Res 2013; 15:e201. [PMID: 24067267 PMCID: PMC3785999 DOI: 10.2196/jmir.2296] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2012] [Revised: 03/04/2013] [Accepted: 06/16/2013] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND It is estimated that 30% of adults in the United States experience daily chronic pain. This results in a significant burden on the health care system, in particular primary care, and on the workplace. Chronic pain management with cognitive-behavioral psychological treatment is effective in reducing pain intensity and interference, health-related quality of life, mood, and return to work. However, the population of individuals with chronic pain far exceeds the population of therapists that can provide this care face-to-face. The use of tailored, Web-based interventions for the management of chronic pain could address limitations to access by virtue of its unlimited scalability. OBJECTIVE To examine the effects of a tailored Web-based chronic pain management program on subjective pain, activity and work interference, quality of life and health, and stress. METHODS Eligible participants accessed the online pain management program and informed consent via participating employer or health care benefit systems; program participants who completed baseline, 1-, and 6-month assessments were included in the study. Of the 645 participants, the mean age was 56.16 years (SD 12.83), most were female (447/645, 69.3%), and white (505/641, 78.8%). Frequent pain complaints were joint (249/645, 38.6%), back (218/645, 33.8%), and osteoarthritis (174/654, 27.0%). The online pain management program used evidence-based theories of cognitive behavioral intervention, motivational enhancement, and health behavior change to address self-management, coping, medical adherence, social support, comorbidities, and productivity. The program content was individually tailored on several relevant participant variables. RESULTS Both pain intensity (mean 5.30, SD 2.46), and unpleasantness (mean 5.43, SD 2.52) decreased significantly from baseline to 1-month (mean 4.16, SD 2.69 and mean 4.24, 2.81, respectively) and 6-month (mean 3.78, SD 2.79 and mean 3.78, SD 2.79, respectively) assessments (P<.001). The magnitude of the 6-month effects were large. Trends for decreases in pain interference (36.8% reported moderate or enormous interference) reached significance at 6 months (28.9%, P<.001). The percentage of the sample reporting fair or poor quality of life decreased significantly from 20.6% at baseline to 16.5% at 6 months (P=.006). CONCLUSIONS Results suggest that the tailored online chronic pain management program showed promising effects on pain at 1 and 6 months posttreatment and quality of life at 6 months posttreatment in this naturalistic study. Further research is warranted to determine the significance and magnitude of the intervention's effects in a randomized controlled trial.
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Affiliation(s)
- Dana C Nevedal
- VA Connecticut Healthcare System, Department of Clinical Health Psychology, West Haven, CT, USA.
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Pergolizzi J, Ahlbeck K, Aldington D, Alon E, Coluzzi F, Dahan A, Huygen F, Kocot-Kępska M, Mangas AC, Mavrocordatos P, Morlion B, Müller-Schwefe G, Nicolaou A, Pérez Hernández C, Sichère P, Schäfer M, Varrassi G. The development of chronic pain: physiological CHANGE necessitates a multidisciplinary approach to treatment. Curr Med Res Opin 2013; 29:1127-35. [PMID: 23786498 PMCID: PMC3793283 DOI: 10.1185/03007995.2013.810615] [Citation(s) in RCA: 74] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Chronic pain is currently under-diagnosed and under-treated, partly because doctors' training in pain management is often inadequate. This situation looks certain to become worse with the rapidly increasing elderly population unless there is a wider adoption of best pain management practice. This paper reviews current knowledge of the development of chronic pain and the multidisciplinary team approach to pain therapy. The individual topics covered include nociceptive and neuropathic pain, peripheral sensitization, central sensitization, the definition and diagnosis of chronic pain, the biopsychosocial model of pain and the multidisciplinary approach to pain management. This last section includes an example of the implementation of a multidisciplinary approach in Belgium and describes the various benefits it offers; for example, the early multidimensional diagnosis of chronic pain and rapid initiation of evidence-based therapy based on an individual treatment plan. The patient also receives continuity of care, while pain relief is accompanied by improvements in physical functioning, quality of life and emotional stress. Other benefits include decreases in catastrophizing, self-reported patient disability, and depression. Improved training in pain management is clearly needed, starting with the undergraduate medical curriculum, and this review is intended to encourage further study by those who manage patients with chronic pain.
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Affiliation(s)
- Joseph Pergolizzi
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
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Schaafsma FG, Whelan K, van der Beek AJ, van der Es‐Lambeek LC, Ojajärvi A, Verbeek JH. Physical conditioning as part of a return to work strategy to reduce sickness absence for workers with back pain. Cochrane Database Syst Rev 2013; 2013:CD001822. [PMID: 23990391 PMCID: PMC7074637 DOI: 10.1002/14651858.cd001822.pub3] [Citation(s) in RCA: 50] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Physical conditioning as part of a return to work strategy aims to improve work status for workers on sick leave due to back pain. This is the second update of a Cochrane Review (originally titled 'Work conditioning, work hardening and functional restoration for workers with back and neck pain') first published in 2003, updated in 2010, and updated again in 2013. OBJECTIVES To assess the effectiveness of physical conditioning as part of a return to work strategy in reducing time lost from work and improving work status for workers with back pain. Further, to assess which aspects of physical conditioning are related to a faster return to work for workers with back pain. SEARCH METHODS We searched the following databases to March 2012: CENTRAL, MEDLINE (from 1966), EMBASE (from 1980), CINAHL (from 1982), PsycINFO (from 1967), and PEDro. SELECTION CRITERIA Randomized controlled trials (RCTs) and cluster RCTs that studied workers with work disability related to back pain and who were included in physical conditioning programmes. DATA COLLECTION AND ANALYSIS Two review authors independently extracted data and assessed risk of bias. We used standard methodological procedures expected by The Cochrane Collaboration. MAIN RESULTS We included 41 articles reporting on 25 RCTs with 4404 participants. Risk of bias was low in 16 studies.Three studies involved workers with acute back pain, eight studies workers with subacute back pain, and 14 studies workers with chronic back pain.In 14 studies, physical conditioning as part of a return to work strategy was compared to usual care. The physical conditioning mostly consisted of graded activity with work-related exercises aimed at increasing back strength and flexibility, together with a set date for return to work. The programmes were divided into a light version with a maximum of five sessions, or an intense version with more than five sessions up to full time or as inpatient treatment.For acute back pain, there was low quality evidence that both light and intense physical conditioning programmes made little or no difference in sickness absence duration compared with care as usual at three to 12 months follow-up (3 studies with 340 workers).For subacute back pain, the evidence on the effectiveness of intense physical conditioning combined with care as usual compared to usual care alone was conflicting (four studies with 395 workers). However, subgroup analysis showed low quality evidence that if the intervention was executed at the workplace, or included a workplace visit, it may have reduced sickness absence duration at 12 months follow-up (3 studies with 283 workers; SMD -0.42, 95% CI -0.65 to -0.18).For chronic back pain, there was low quality evidence that physical conditioning as part of integrated care management in addition to usual care may have reduced sickness absence days compared to usual care at 12 months follow-up (1 study, 134 workers; SMD -4.42, 95% CI -5.06 to -3.79). What part of the integrated care management was most effective remained unclear. There was moderate quality evidence that intense physical conditioning probably reduced sickness absence duration only slightly compared with usual care at 12 months follow-up (5 studies, 1093 workers; SMD -0.23, 95% CI -0.42 to -0.03).Physical conditioning compared to exercise therapy showed conflicting results for workers with subacute and chronic back pain. Cognitive behavioural therapy was probably not superior to physical conditioning as an alternative or in addition to physical conditioning. AUTHORS' CONCLUSIONS The effectiveness of physical conditioning as part of a return to work strategy in reducing sick leave for workers with back pain, compared to usual care or exercise therapy, remains uncertain. For workers with acute back pain, physical conditioning may have no effect on sickness absence duration. There is conflicting evidence regarding the reduction of sickness absence duration with intense physical conditioning versus usual care for workers with subacute back pain. It may be that including workplace visits or execution of the intervention at the workplace is the component that renders a physical conditioning programme effective. For workers with chronic back pain physical conditioning has a small effect on reducing sick leave compared to care as usual after 12 months follow-up. To what extent physical conditioning as part of integrated care management may alter the effect on sick leave for workers with chronic back pain needs further research.
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Affiliation(s)
- Frederieke G Schaafsma
- VU University Medical Center, EMGO+ InstituteDepartment of Public and Occupational HealthVan der Boechorststraat 7 ‐ room A524Postbus 7057AmsterdamNetherlands1007 MB
| | - Karyn Whelan
- Australian Catholic UniversitySchool of Physiotherapy, Faculty of Health SciencesLevel 2, 173 Pacific HighwayNorth SydneyAustraliaNSW 2060
| | - Allard J van der Beek
- VU University Medical CenterDepartment of Public and Occupational Health, EMGO InstituteVan der Boechorststraat 7AmsterdamNetherlandsNL‐1081 BT
| | | | - Anneli Ojajärvi
- Finnish Institute of Occupational HealthTopeliuksenkatu 41 a AHelsinkiFinlandFI‐00250
| | - Jos H Verbeek
- Finnish Institute of Occupational HealthCochrane Occupational Safety and Health Review GroupPO Box 310KuopioFinland70101
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50
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Abstract
OBJECTIVES To evaluate the efficacy of yoga as an intervention for chronic low back pain (CLBP) using a meta-analytical approach. Randomized controlled trials (RCTs) that examined pain and⁄or functional disability as treatment outcomes were included. Post-treatment and follow-up outcomes were assessed. METHODS A comprehensive search of relevant electronic databases, from the time of their inception until November 2011, was conducted. Cohen's d effect sizes were calculated and entered in a random-effects model. RESULTS Eight RCTs met the criteria for inclusion (eight assessing functional disability and five assessing pain) and involved a total of 743 patients. At post-treatment, yoga had a medium to large effect on functional disability (d=0.645) and pain (d=0.623). Despite a wide range of yoga styles and treatment durations, heterogeneity in post-treatment effect sizes was low. Follow-up effect sizes for functional disability and pain were smaller, but remained significant (d=0.397 and d=0.486, respectively); however, there was a moderate to high level of variability in these effect sizes. DISCUSSION The results of the present study indicate that yoga may be an efficacious adjunctive treatment for CLBP. The strongest and most consistent evidence emerged for the short-term benefits of yoga on functional disability. However, before any definitive conclusions can be drawn, there are a number of methodological concerns that need to be addressed. In particular, it is recommended that future RCTs include an active control group to determine whether yoga has specific treatment effects and whether yoga offers any advantages over traditional exercise programs and other alternative therapies for CLBP.
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