Differing Psychologically Derived Clusters in People With Chronic Low Back Pain are Associated With Different Multidimensional Profiles

Rabey, Martin; Smith, Anne; Beales, Darren; Slater, Helen; O’Sullivan, Peter

doi:10.1097/ajp.0000000000000363

Cited by 64 publications

(46 citation statements)

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“…The high‐risk subgroup is defined by higher psychological distress. Prior investigation in this cohort reported a weak association between psychological distress and pain summation following repeated spinal bending (Rabey et al, ), consistent with results reported here.…”

Section: Discussionsupporting

confidence: 91%

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STarT Back Tool risk stratification is associated with changes in movement profile and sensory discrimination in low back pain: A study of 290 patients

Rabey

Kendell

Godden

et al. 2019

European Journal of Pain

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Background Investigation of movement and sensory profiles across STarT Back risk subgroups. Methods A chronic low back pain cohort (n = 290) were classified as low, medium or high risk using the STarT Back Tool, and completed a repeated spinal bending task and quantitative sensory testing. Pain summation, time taken and the number of protective behaviours with repeated bending were measured. Sensory tests included two‐point discrimination, temporal summation, pressure/thermal pain thresholds and conditioned pain modulation. Subgroups were profiled against movement and sensory variables. Results The high‐risk subgroup demonstrated greater pain summation following repeated forward bending (p < 0.001). The medium‐risk subgroup demonstrated greater pain summation following repeated backward bending (p = 0.032). Medium‐ and high‐risk subgroups demonstrated greater forward/backward bend time compared to the low‐risk subgroup (p = 0.001, p = 0.005, respectively). Medium‐ and high‐risk subgroups demonstrated a higher number of protective behaviours per forward bend compared to the low‐risk subgroup (p = 0.008). For sensory variables, only two‐point discrimination differed between subgroups, with medium‐ and high‐risk subgroups demonstrating higher thresholds (p = 0.016). Conclusions This study showed altered movement characteristics and sensory discrimination across SBT risk subgroups in people with CLBP. Membership of the high SBT risk subgroup was associated with greater pain and disability levels, greater pain summation following repeated bending, slower bending times, a greater number of protective behaviours during forward bending, and a higher TPD threshold. Treatment outcomes for higher risk SBT subgroups may be enhanced by interventions specifically targeting movement and sensory alterations. Significance In 290 people with chronic low back pain movement profile and two‐point discrimination threshold differed across risk subgroups defined by the STarT Back Tool. Conversely, pain sensitivity did not differ across these subgroups. These findings may add further guidance for targeted care in these subgroups.

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Section: Discussionsupporting

confidence: 91%

“…Prior publications involving this cohort have not considered the movement and sensory profiles of SBT risk subgroups (Kendell et al, ; Rabey, Poon et al, ; Rabey et al, ; Rabey, Smith, Beales, Slater, & O'Sullivan, ).…”

Section: Methodsmentioning

confidence: 99%

STarT Back Tool risk stratification is associated with changes in movement profile and sensory discrimination in low back pain: A study of 290 patients

Rabey

Kendell

Godden

et al. 2019

European Journal of Pain

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“…Patients with low-level pain intensity had greater satisfaction than patients with high level pain intensity. Patients with severe pain can have other combined symptoms such as depression, anxiety, and impaired sleep [1819]. Therefore, for the treatment of patients with severe pain, a multimodal approach and intensive treatment may be necessary.…”

Section: Discussionmentioning

confidence: 99%

Sufficient explanation of management affects patient satisfaction and the practice of post-treatment management in spinal pain, a multicenter study of 1007 patients

et al. 2017

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BackgroundSpinal pain is most common symptom in pain clinic. In most cases, before the treatment of spinal pain, physician explains the patient's disease and treatment. We investigated patient's satisfaction and physician's explanation related to treatments in spinal pain patients by questionnaires.MethodsAnonymous questionnaires about physician's explanation and patient's satisfaction in each treatment and post-treatment management were asked to individuals suffering from spinal pain. Patients who have spinal pain were participated in our survey of nationwide university hospitals in Korea. The relationships between patient's satisfaction and other factors were analyzed.ResultsBetween June 2016 and August 2016, 1007 patients in 37 university hospitals completed the questionnaire. In the statistical analysis, patient's satisfaction of treatment increased when pain severity was low or received sufficient preceding explanation about nerve block and medication (P < 0.01). Sufficient explanation increased patient's necessity of a post-treatment management and patients' performance rate of post-treatment management (P < 0.01).ConclusionsThese results show that sufficient explanation increased patients' satisfaction after nerve block and medication. Sufficient explanation also increased the practice of patients' post-treatment management.

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“…With respect to these comments, we consider that our model is client-centered, multidimensional, and most importantly, gives to the clinician a structure to better target the multiple dimensions associated with LBP, while remaining relatively simple. Although a more comprehensive biopsychosocial profiling of patients with LBP has recently been explored,104 it remains challenging to clinically interpret results from cluster analysis and to translate these findings into clinical practice.…”

Section: Part 3: Potential Advantages Of This Integrative Model and Imentioning

confidence: 99%

Rehabilitation management of low back pain – it’s time to pull it all together!

Tousignant-Laflamme

Martel

Joshi

et al. 2017

JPR

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In the past, rehabilitation research initiatives for low back pain (LBP) have targeted outcome enhancement through personalized treatment approaches, namely through classification systems (CS). Although the use of CS has enhanced outcomes, common management practices have not changed, the prevalence of LBP is still high, and only selected patients meet the CS profile, namely those with a nociceptive context. Similarly, although practice guidelines propose some level of organization and occasionally a timeline of care provision, each mainly provides best practice for isolated treatment approaches. Moreover, there is no theoretical framework that has been proposed that guides the rehabilitation management process of mechanical LBP. In this commentary, we propose a model constituted of five domains (nociceptive drivers, nervous system dysfunction drivers, comorbidities drivers, cognitive–emotional drivers, and contextual drivers) grounded as mechanisms driving pain and/or disability in LBP. Each domain is linked to the International Classification of Functioning, Disability and Health, where once a patient is deemed suitable for rehabilitation, the clinician assesses elements of each domain in order to identify where the relative treatment efforts should be focused. This theoretical model is designed to provide a more comprehensive management overview, by appreciating the relative contribution of each domain driving pain and disability. Considering that the multiple domains driving pain and disability, and their interaction, requires a model that is comprehensive enough to identify and address each related issue, we consider that the proposed model has several positive implications for rehabilitation of this painful and highly prevalent musculoskeletal disorder.

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Differing Psychologically Derived Clusters in People With Chronic Low Back Pain are Associated With Different Multidimensional Profiles

Abstract: Clinical implications relating to presentations of each cluster are postulated.

Cited by 64 publications

References 93 publications

STarT Back Tool risk stratification is associated with changes in movement profile and sensory discrimination in low back pain: A study of 290 patients

STarT Back Tool risk stratification is associated with changes in movement profile and sensory discrimination in low back pain: A study of 290 patients

Sufficient explanation of management affects patient satisfaction and the practice of post-treatment management in spinal pain, a multicenter study of 1007 patients

Rehabilitation management of low back pain – it’s time to pull it all together!

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Differing Psychologically Derived Clusters in People With Chronic Low Back Pain are Associated With Different Multidimensional Profiles

Abstract: Clinical implications relating to presentations of each cluster are postulated.

Cited by 64 publications

References 93 publications

STarT Back Tool risk stratification is associated with changes in movement profile and sensory discrimination in low back pain: A study of 290 patients

STarT Back Tool risk stratification is associated with changes in movement profile and sensory discrimination in low back pain: A study of 290 patients

Sufficient explanation of management affects patient satisfaction and the practice of post-treatment management in spinal pain, a multicenter study of 1007 patients

Rehabilitation management of low back pain &ndash; it&rsquo;s time to pull it all together!

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Rehabilitation management of low back pain – it’s time to pull it all together!