Low Back Pain in Primary Care

Becker, Annette; Held, Heiko; Redaélli, Marcus; Strauch, Konstantin; Chenot, Jean‐François; Leonhardt, Corinna; Keller, Stefan; Baum, Erika; Pfingsten, M.; Hildebrandt, J.; Basler, Heinz-Dieter; Kochen, Michael M.; Donner-Banzhoff, Norbert

doi:10.1097/brs.0b013e3181cd656f

Cited by 245 publications

(109 citation statements)

References 25 publications

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“…Including both direct and indirect costs, chronic pain imposes the greatest economic burden of any health condition (Ferrari & Russell, 2003; Stewart, Ricci, Chee, Morganstein, & Lipton, 2003). Persistent back pain in particular is one of the principal drivers of these costs, both in the U.S. (Becker, et al , 2010) and internationally (Hoy, et al , 2010), with indirect costs (e.g., lost or reduced work productivity) accounting for more than half of this economic burden (Phillips & Harper, 2011). In addition, the presence of a long-lasting pain syndrome is a leading risk factor for suicide, and psychosocial variables play crucial roles as risk factors or protective factors for suicidality in pain patients (Edwards, Bingham, Bathon, & Haythornthwaite, 2006).…”

Section: Background and Overview Of Pain Issuesmentioning

confidence: 99%

Integrating Pain Management in Clinical Practice

Jamison

Edwards

2012

J Clin Psychol Med Settings

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There is much evidence to suggest that psychological and social issues are predictive of pain severity, emotional distress, work disability, and response to medical treatments among persons with chronic pain. Psychologists can play an important role in the identification of psychological and social dysfunction and in matching personal characteristics to effective interventions as part of a multidisciplinary approach to pain management, leading to a greater likelihood of treatment success. The assessment of different domains using semi-structured clinical interviews and standardized self-report measures permits identification of somatosensory, emotional, cognitive, behavioral and social issues in order to facilitate treatment planning. We briefly describe measures to assess constructs related to pain and intervention strategies for the behavioral treatment of chronic pain and discuss related psychiatric and substance abuse issues. Finally, we offer a future look at the role of integrating pain management in clinical practice in the psychological assessment and treatment for persons with chronic pain.

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Section: Background and Overview Of Pain Issuesmentioning

confidence: 99%

Integrating Pain Management in Clinical Practice

Jamison

Edwards

2012

J Clin Psychol Med Settings

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“…Although most patients recover completely within 4–8 weeks, a subset of patients is prone to develop chronic low back pain (CLBP). CLBP has become a major challenge for public health care systems worldwide [1]. The prevalence of CLBP is about 23%; around 12% of the afflicted patients are severely disabled [2], [3].…”

Section: Introductionmentioning

confidence: 99%

Disrupted TH17/Treg Balance in Patients with Chronic Low Back Pain

et al. 2014

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Chronic low back pain (CLBP) is a leading cause of disability and costs in health care systems worldwide. Despite extensive research, the exact pathogenesis of CLBP, particularly the individual risk of chronification remains unclear. To investigate a possible role of the adaptive immune system in the pathophysiology of CLBP, we analyzed T cell related cytokine profiles, T cell related mRNA expression patterns and the distribution of T cell subsets in 37 patients suffering from nonspecific CLBP before and after multimodal therapy in comparison to 25 healthy controls. Serum patterns of marker cytokines were analyzed by Luminex technology, mRNA expression of cytokines and specific transcription factors was measured by real-time PCR, and distribution of TH1-, TH2-, TH17- and regulatory T cell (Tregs) subsets was determined by multicolor flow cytometry. We found that CLBP patients exhibit an increased number of anti-inflammatory Tregs, while pro-inflammatory TH17 cells are decreased, resulting in an altered TH17/Treg ratio. Accordingly, FoxP3 and TGF-β-mRNA expression was elevated, while expression of IL-23 was reduced. Serum cytokine analyses proved to be unsuitable to monitor the adaptive immune response in CLBP patients. We further show that even after successful therapy with lasting reduction of pain, T cell subset patterns remained altered after a follow-up period of 6 months. These findings suggest an involvement of TH17/Treg cells in the pathogenesis of CLBP and emphasize the importance of these cells in the crosstalk of pain and immune response.Trial RegistrationGerman Clinical Trial Register: Registration Trial DRKS00005954.

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“…Available diagnostic tests are controversial [2, 3, 26, 27]. Although some authors insist on a strict separation of NRS and VAS [28], pain intensity was assessed using a combined scale in the ManRück study, which was shown to be both easy for patients to handle and precise for data analysis and calculations.…”

Section: Discussionmentioning

confidence: 99%

“…The high socioeconomic burden caused by the direct and indirect costs of LBP has often been described [3, 4]. More importantly, patients’ quality of life is markedly reduced.…”

Section: Introductionmentioning

confidence: 99%

Manual therapy applied by general practitioners for nonspecific low back pain: results of the ManRück pilot-study

et al. 2018

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BackgroundNonspecific acute low back pain (LBP) is a common reason for accessing primary care. German guidelines recommend non-steroidal anti-inflammatory drugs and physical activity as evidence-based treatments. Manual Therapy (MT) remains controversial. To increase evidence-based treatment options for general practitioners (GPs), a Pilot-Study was set up to gather information about the required conditions and setting for an RCT.MethodsThe open pilot-study assesses recruitment methods for GPs and patients, timelines, data collection and outcomes of treatment immediately (T0) and 1, 6 and 12 weeks after consultation (T1, T2, T3). Inclusion criteria for GPs were: no experience of MT; for patients: adults between 18 and 50 suffering from LBP for less than 14 days.Study process: Patients’ control-group (CG) was consecutively recruited first and received standard care. After GPs received a single training session in MT lasting two and a half hours, they consecutively recruited patients with LBP to the intervention group (IG). These patients received add-on MT.Primary outcomes: (A): timelines and recruitment success, (B): assessment tools and sample size evaluation, (C) clinical findings: pain intensity change from baseline to day 3 and time till (a) analgesic use stopped and (b) 2-point pain reduction on an 11-point scale occurred.Secondary outcomes: functional capacity, referral rate, use of other therapies, sick leave, patient satisfaction.Results14 GPs participated, recruiting 42 patients for the CG and 45 for the IG; 49% (56%) of patients were women. Average baseline pain was 5.98 points, SD: ±2.3 (5.98, SD ±1.8).For an RCT an extended timeline and enhanced recruitment procedures are required. The assessment tools seem appropriate and provided relevant findings: additional MT led to faster pain reduction. IG showed reduced analgesic use and reduced pain at T1 and improved functional capacity by T2.ConclusionsBefore verifying the encouraging findings that additional MT may lead to faster pain reduction and reduced analgesic use via an RCT, the setting, patients’ structure, and inclusion criteria should be considered more closely.Trial registrationNumber: DRKS00003240 Registry: German Clinical Trials Registry (DRKS) URL: https://www.drks.de/drks_web/. Registration date: 14.11.2011. First patient: March 2012. Funding: the Rut and Klaus Bahlsen Stiftung, Hannover.

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Low Back Pain in Primary Care

Abstract: Interventions designed to reduce high health care costs for LBP should focus on patients with severe LBP and depressive comorbidity. Our results add to the economic understanding of LBP care and may give guidance for future actions on health care improvement and cost reduction.

Cited by 245 publications

References 25 publications

Integrating Pain Management in Clinical Practice

Integrating Pain Management in Clinical Practice

Disrupted TH17/Treg Balance in Patients with Chronic Low Back Pain

Manual therapy applied by general practitioners for nonspecific low back pain: results of the ManRück pilot-study

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