Comparison of physical treatments versus a brief pain management programme for back pain in primary care: A randomised clinical trial in physiotherapy practice

Primary Care Sciences Research Centre, Keele University, Staffordshire, UK.
The Lancet (Impact Factor: 45.22). 06/2005; 365(9476). DOI: 10.1016/S0140-6736(05)66696-2
Source: OAI

ABSTRACT Recommendations for the management of low back pain in primary care emphasise the importance of recognising and addressing psychosocial factors at an early stage. We compared the effectiveness of a brief pain-management programme with physiotherapy incorporating manual therapy for the reduction of disability at 12 months in patients consulting primary care with subacute low back pain.
For this pragmatic, multicentre, randomised clinical trial, eligible participants consulted primary care with non-specific low back pain of less than 12 weeks' duration. They were randomly assigned either a programme of pain management (n=201) or manual therapy (n=201). The primary outcome was change in the score on the Roland and Morris disability questionnaire at 12 months. Analysis was by intention to treat.
Of 544 patients assessed for eligibility, 402 were recruited (mean age 40.6 years) and 329 (82%) reached 12-month follow-up. Mean disability scores were 13.8 (SD 4.8) for the pain-management group and 13.3 (4.9) for the manual-therapy group. The mean decreases in disability scores were 8.8 (6.4) and 8.8 (6.1) at 12 months (difference 0 [95% CI -1.3 to 1.4], p=0.99), and median numbers of physiotherapy visits per patient were three (IQR one to five) and four (two to five), respectively (p=0.001). One adverse reaction (an exacerbation of pain after the initial assessment) was recorded.
Brief pain management techniques delivered by appropriately trained clinicians offer an alternative to physiotherapy incorporating manual therapy and could provide a more efficient first-line approach for management of non-specific subacute low back pain in primary care.

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Available from: Chris J Main, Aug 20, 2015
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    • "CLBP may affect both functioning and quality of life mediated by decrease in physical, emotional and social factors. Physiotherapists have accordingly shifted towards a biopsychosocial approach and there is evidence that a biomedical approach is insufficiently effective (Hay et al. 2005). There are multiple biopsychosocial treatment options which are currently evidence based including cognitive therapy combined with exercise therapy, operant approaches or contextual treatment such as mindfulness or acceptance and commitment therapy (ACT) (Keefe et al. 2004). "
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    ABSTRACT: The aim of this study was to explore on which variables a stress reduction program based on heart coherence can enhance the effects of a back school (BS) in patients with chronic non-specific low back pain and to explore possible moderators for treatment success. A retrospective explorative design was carried out with 170 patients with chronic non-specific low back pain. 89 Patients were admitted to BS and 81 patients were selected for BS and heart coherence training (BS-HCT). Six sessions of heart coherence were provided. At T0 (baseline) and T1 (discharge), the Numeric Rating Scale for pain (NRS pain), Roland Morris Disability Questionnaire (RMDQ), Pain Disability Index (PDI) and Rand-36 were administered in both groups. Both groups improved significantly on NRS pain, RMDQ, PDI and most of the Rand-36 subscales. On physical functioning, the BS-HCT group improved significantly more than the BS group (p = 0.02) but not after Bonferroni correction. Significant moderate correlations (r = 0.39 and r = 0.48) were found between the change of heart coherence and change of PDI and RMDQ respectively, but not with other variables. Baseline characteristics were not related to change on heart coherence. Providing HCT was more effective on physical functioning compared to a BS program. Change in heart coherence was related significantly to 2 out of 12 analyses. Placebo controlled and blinded studies are needed to confirm this. Characteristics of individuals who might benefit remain unknown. Evidence of this study is considered a level C, because of its pragmatic clinical character.
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    • "Low back pain (LBP) is the most common form of back pain. It may be restricted to the back areas (low-back, midback and high-back) or may radiate down one or both legs (Goldestein, 2002), and has been defined as pain or discomfort felt in the area bounded superiorly by T12 and inferiorly by the buttock creases (Watson et al, 2005). Low back pain is the most common cause of absence from work for both men and women between 20 and 65 years of age (Walsh et al, 1990). "
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    • "After screening full-text articles for those 19 studies, only six were deemed eligible [26,28,29,31–33]. Reasons for excluding full-text articles included duplicate reports (n58) [34– 38,40–42], less than 20 participants per study group (n51) [27], not being able to distinguish separate effects of multimodal intervention (n51) [30], mixed neck and back pain (n51) [44], no patient-reported outcomes (n51) [39], and no acute LBP (n51) [43] (Figure). An additional eight eligible studies [45] [46] [47] [48] [49] [50] [51] [52] were identified from two previous SRs on similar topics [23] [53]. "
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