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