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CME

Multidisciplinary Treatment May Benefit Patients With Chronic Low Back Pain

  • Authors: News Author: Laurie Barclay, MD
    CME Author: Hien T. Nghiem, MD
  • CME Released: 12/27/2007; Reviewed and Renewed: 12/26/2008
  • THIS ACTIVITY HAS EXPIRED
  • Valid for credit through: 12/26/2009
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Target Audience and Goal Statement

This article is intended for primary care clinicians, orthopaedists, and other specialists who care for patients with chronic low back pain.

The goal of this activity is to provide medical news to primary care clinicians and other healthcare professionals in order to enhance patient care.

Upon completion of this activity, participants will be able to:

  1. Report the socioeconomic impact of chronic low back pain.
  2. Determine whether patients in all stages of chronicity benefit from multidisciplinary therapy for chronic low back pain.


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Medscape, LLC encourages Authors to identify investigational products or off-label uses of products regulated by the US Food and Drug Administration, at first mention and where appropriate in the content.


Author(s)

  • Laurie Barclay, MD

    Laurie Barclay, MD, is a freelance reviewer and writer for Medscape.

    Disclosures

    Disclosure: Laurie Barclay, MD, has disclosed no relevant financial relationships.

Editor(s)

  • Brande Nicole Martin

    Brande Nicole Martin is the News CME editor for Medscape Medical News.

    Disclosures

    Disclosure: Brande Nicole Martin has disclosed no relevant financial information.

CME Author(s)

  • Hien T Nghiem, MD

    Writer for Medscape Medical News

    Disclosures

    Disclosure: Hien T. Nghiem, MD, has disclosed no relevant financial relationships.


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CME

Multidisciplinary Treatment May Benefit Patients With Chronic Low Back Pain

Authors: News Author: Laurie Barclay, MD CME Author: Hien T. Nghiem, MDFaculty and Disclosures
THIS ACTIVITY HAS EXPIRED

CME Released: 12/27/2007; Reviewed and Renewed: 12/26/2008

Valid for credit through: 12/26/2009

processing....

December 27, 2007 — Multidisciplinary treatment strategies are effective for patients with chronic low back pain (CLBP) in all stages of chronicity and should not only be given to those with lower grades of CLBP, according to the results of a prospective longitudinal clinical study reported in the December 15 issue of Spine.

"The treatment of choice for patients with CLBP seems to be a multidisciplinary therapy incorporating multiple treatment components, such as intensive physical exercises and biopsychosocial and behavioral interventions," write Matthias Buchner, MD, PhD, from the University of Heidelberg in Germany, and colleagues. "This prospective clinical study with a 6 months' duration is, to the authors' knowledge, the first to evaluate separately the prognostic value of the chronicity stage in the therapy outcome of patients with CLBP treated with a multidisciplinary biopsychosocial therapy approach."

In this study, 387 patients with CLBP for at least 3 months associated with sick leave for at least 6 weeks underwent standardized multidisciplinary therapy for 3 weeks. At baseline, patients were placed in 3 groups of chronicity graded using the classification of von Korff and colleagues (group A, grades I and II; group B, grade III; group C, grade IV) and were followed prospectively.

At 6-month follow-up, the 3 groups were compared for back-to-work status, generic health status measured with the 36-Item Short Form Health Survey (SF-36), pain intensity measured with the visual analog scale, functional capacity measured with the Hannover back capacity score, and satisfaction with their therapy.

At baseline, patients in group C had a higher pain level, a longer pain history, and more generalized as well as psychosomatic comorbidities vs patients in groups A and B. From baseline to 6 months, all outcome criteria improved significantly in all 3 treatment groups, and the back-to-work rate in the total patient sample was 67.4%.

At the final follow-up, patients with lower grades of chronicity had significantly better outcomes in functional capacity and pain level, but these were mostly attributed to worse values at baseline. At 6 months, there were no significant differences among groups in back-to-work rate, satisfaction with therapy, and the Mental Component Summary of the SF-36.

"According to the results of this study, patients with chronic low back pain also derive significant benefit from a multidisciplinary treatment strategy in higher stages of chronicity," the study authors write. "Therefore, therapy should not be limited to the patients in lower stages of chronicity."

This study has received no external funding, and the study authors have disclosed no relevant financial relationships.

Spine. 2007;32:3060-3066.

Clinical Context

CLBP is not only a serious problem for our healthcare system, but it also has a significant socioeconomic effect. The major costs of CLBP are the consequence of loss of productivity, work absenteeism, and disablement. According to a study by von Korff and colleagues, CLBP correlated strongly with chronic pain grade and unemployment rate, functional limitations, depression, self-rated health, use of opioid analgesics, and pain-related clinician visits at baseline and also at 1-year follow-up. Systematic reviews have supported multidisciplinary therapy as the treatment of choice for CLBP. It incorporates multiple treatment components, such as intensive physical exercises and biopsychosocial and behavioral interventions.

The aim of the study was to analyze the outcome of different stages of chronicity in patients with CLBP treated with multidisciplinary therapy.

Study Highlights

  • In this prospective longitudinal clinical study, a total of 387 patients (241 women and 164 men; average age, 44.1 years) with CLBP for 3 months or longer and a corresponding sick leave for longer than 6 weeks underwent 3-week standardized multidisciplinary therapy. They were followed up for 6 months.
  • All patients had already undergone all conventional forms of biomedical treatment before being referred to this study.
  • At baseline (T0), patients were assigned into 3 groups of chronicity grades according to the classification of von Korff and colleagues (group A, grades I and II; group B, grade III; group C, grade IV) and were followed prospectively. No patient in this study was pain-free (grade 0).
  • The multidisciplinary treatment is a biopsychosocial therapy strategy based on biologic, social, and psychologic aspects.
  • At the 6-month follow-up (T1), 5 different therapy outcomes were analyzed and were compared in the 3 groups: back-to-work status, generic health status (SF-36), pain intensity (visual analog scale), functional capacity (Hannover back capacity score), and satisfaction with the therapy.
  • At T0, patients in group C had a higher pain level, a longer history of pain, and more general and more psychosomatic comorbidities than patients with lower levels of chronicity.
  • Results revealed that all 3 treatment groups improved significantly in all outcome criteria between T0 and T1.
  • In the total group, the back-to-work rate was 67.4%.
  • At the final follow-up, there were significantly better results in functional capacity and pain level in patients with lower grades of chronicity, mostly because of worse initial baseline values.
  • Back-to-work rate, satisfaction with therapy, and the Mental Component Summary of the SF-36 did not show a significant difference at T1 among the groups analyzed.

Pearls for Practice

  • The socioeconomic effect of CLBP is the costs associated with loss of productivity, work absenteeism, and disablement.
  • Multidisciplinary therapy for patients with CLBP can be recommended for patients in all stages of chronicity.

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