Daniel C Cherkin's research while affiliated with Kaiser Permanente Washington Health Research Institute and other places
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Publications (171)
Both mindfulness-based stress reduction (MBSR) and cognitive-behavioral therapy (CBT) are effective for chronic low back pain (CLBP), but little is known regarding who might benefit more from one than the other. Using data from a randomized trial comparing MBSR, CBT, and usual care (UC) for adults aged 20-70 years with CLBP (N = 297), we examined b...
Background:
Information on the prevalence of common imaging findings among patients without back pain in spine imaging reports might affect pain medication prescribing for patients with back pain. Prior research on inserting this text suggested a small reduction in opioid prescribing.
Objective:
To evaluate the effect of epidemiologic informatio...
Interest in identifying safe and effective nonpharmacological treatments for chronic or recurrent pain conditions has rapidly grown in recent years, largely because of growing concerns about the adverse effects and questionable effectiveness of opioids and other pharmacological treatments. In this issue of JAMA Internal Medicine, Wells and colleagu...
Background:
The Subgrouping for Targeted Treatment (STarT Back) is a stratified care approach to low back pain (LBP) treatment. The predictive validity of STarT Back in Veterans Affairs (VA) primary care has not been demonstrated.
Objective:
To examine the validity of the STarT Back tool for predicting future persistent disabling LBP in VA prima...
Importance:
Lumbar spine imaging frequently reveals findings that may seem alarming but are likely unrelated to pain. Prior work has suggested that inserting data on the prevalence of imaging findings among asymptomatic individuals into spine imaging reports may reduce unnecessary subsequent interventions.
Objective:
To evaluate the impact of in...
Despite improved knowledge about the benefits and harms of treatments for chronic back pain in the past several decades, there is a large and consequential mismatch between treatments found safe and effective and those routinely covered by health insurance. As a result, care for back pain has, if anything, deteriorated in recent decades—expenses ar...
As a large national healthcare system, Veterans Health Administration (VHA) is ideally suited to build on its work to date and develop a safe, evidence-based, and comprehensive approach to the care of chronic musculoskeletal pain conditions that de-emphasizes opioid use and emphasizes non-pharmacological strategies. The VHA Office of Health Service...
Objective:
To examine the predictive validity of the STarT Back tool for classifying people with back pain into categories of low, medium, and high risk of persistent disabling back pain, in US primary care.
Design:
Secondary analysis of data from participants receiving usual care in a randomized clinical trial.
Setting:
Primary care clinics....
The Institute for Clinical and Economic Review (ICER) recently released a report, Cognitive and Mind-Body Therapies for Chronic Low Back and Neck Pain: Effectiveness and Value.¹ ICER evaluates medical evidence, estimates cost-effectiveness, and convenes public deliberative bodies to help stakeholders interpret and apply their findings to improve pa...
Study design:
Economic evaluation alongside a randomized trial of cognitive-behavioral therapy (CBT) and mindfulness-based stress reduction (MBSR) versus usual care alone (UC) for chronic low-back pain (CLBP).
Objective:
Determine the one-year cost-effectiveness of CBT and MBSR compared to UC.
Summary of background data:
CLBP is expensive in t...
Objective: The aim of the present study was to determine the feasibility of a relaxation‐based
yoga intervention for rheumatoid arthritis, designed and reported in accordance with Delphi
recommendations for yoga interventions for musculoskeletal conditions.
Methods: Participants were recruited from a hospital database, and randomized to either
eigh...
The need for effective treatment options for chronic low back pain has spurred interest in “mind-body” approaches including cognitive behavioral therapy (CBT) and mindfulness-based stress reduction (MBSR). We previously reported that, compared with usual care, MBSR and CBT reduced functional limitations and pain bothersomeness for up to 1 year amon...
In Reply
Drs Gatchel and Licciardone comment that “not all participants attended all group sessions, but it was not stated whether the techniques taught were implemented daily or practiced at home.” In our study, 88.6% of participants attended at least 1 session. Less than 100% session attendance is typical in studies of psychosocial interventions...
Cognitive-behavioral therapy (CBT) is believed to improve chronic pain problems by decreasing patient catastrophizing and increasing patient self-efficacy for managing pain. Mindfulness-based stress reduction (MBSR) is believed to benefit chronic pain patients by increasing mindfulness and pain acceptance. However, little is known about how these t...
Importance:
Mindfulness-based stress reduction (MBSR) has not been rigorously evaluated for young and middle-aged adults with chronic low back pain.
Objective:
To evaluate the effectiveness for chronic low back pain of MBSR vs cognitive behavioral therapy (CBT) or usual care.
Design, setting, and participants:
Randomized, interviewer-blind, cl...
This is the first study to systematically evaluate the value of a longer treatment period for massage. We provide a framework of how to conceptualize an optimal dose in this challenging setting of non-pharmacological treatments.
To determine the optimal dose of massage for neck pain.
Two-phase randomized trial for persons with chronic non-specific...
Background
The relationship between patient expectations about a treatment and the treatment outcomes, particularly for Complementary and Alternative Medicine (CAM) therapies, is not well understood. Using qualitative data from a larger study to develop a valid expectancy questionnaire for use with participants starting new CAM therapies, we examin...
Background: Yoga is a popular complementary and alternative medicine (CAM) therapy among peope with rheumatoid arthritis (RA), perceived as offering self-management options for physical and psychosocial symptoms associated with RA.
Objectives: The primary aims of the current pilot study are (1) to assess the feasibility and safety of a relaxation-f...
Objectives:
To identify the content and reporting details of randomised controlled trials of yoga for musculoskeletal conditions through a systematic review of the literature.
Design:
Twenty electronic databases were searched to identify randomised controlled trials (RCTs) of yoga interventions for musculoskeletal conditions. Eligibility criteri...
Background
Positive patient expectations are often believed to be associated with greater benefits from complementary and alternative medicine (CAM) treatments. However, clinical studies of CAM treatments for chronic pain have not consistently supported this assumption, possibly because of differences in definitions and measures of expectations. Th...
Background
Evidence suggests yoga is a safe and effective intervention for the management of physical and psychosocial symptoms associated with musculoskeletal conditions. However, heterogeneity in the components and reporting of clinical yoga trials impedes both the generalization of study results and the replication of study protocols. The aim of...
Background
The self-reported health and functional status of persons with back pain in the United States have declined in recent years, despite greatly increased medical expenditures due to this problem. Although patient psychosocial factors such as pain-related beliefs, thoughts and coping behaviors have been demonstrated to affect how well patien...
Background
There is a need for more Comparative Effectiveness Research (CER) on Chinese medicine (CM) to inform clinical and policy decision-making. This document aims to provide consensus advice for the design of CER trials on CM for researchers. It broadly aims to ensure more adequate design and optimal use of resources in generating evidence for...
Purpose: To investigate the feasibility and safety of a relaxation-
focussed yoga intervention for rheumatoid arthritis (RA),
developed in accordance with Delphi recommendations for the
design and reporting of yoga interventions for musculoskeletal
conditions.
Methods: Participants were recruited via a hospital database,
and randomized to either an...
Purpose: Review the comparative effectiveness and efficiency
of databases at retrieving articles include in a systematic review
of yoga for musculoskeletal conditions.
Methods: Twenty electronic databases previously used in systematic
reviews of complementary therapies and musculoskeletal
conditions were searched using database-specific search
stra...
Purpose:
This trial was designed to evaluate the optimal dose of massage for individuals with chronic neck pain.
Methods:
We recruited 228 individuals with chronic nonspecific neck pain from an integrated health care system and the general population, and randomized them to 5 groups receiving various doses of massage (a 4-week course consisting...
No consistent relationship exists between pre-treatment expectations and therapeutic benefit from various complementary and alternative medicine (CAM) therapies in clinical trials. However, many different expectancy measures have been used in those studies, with no validated questionnaires clearly focused on CAM and pain. We undertook cognitive int...
Objectives:
Musculoskeletal conditions (MSCs) are the leading cause of disability and chronic pain in the developed world, impacting both functional ability and psychosocial health. The current review investigates the effectiveness of yoga on primary outcomes of functional ability, pain and psychosocial outcomes across a range of MSCs.
Methods:...
Objective: Evidence suggests yoga may result in clinically relevant improvements in pain and
functional outcomes across a range of musculoskeletal conditions including rheumatoid
arthritis, osteoarthritis, and fibromyalgia. The aim of the current study was to develop a set of
standardized core components for yoga therapy in clinical intervention tr...
Although yoga is an effective treatment for chronic low back pain, little is known about the mechanisms responsible for its benefits. In a trial comparing yoga to intensive stretching and self-care, we explored whether physical (hours of back exercise/week), cognitive (fear avoidance, body awareness, and self-efficacy), affective (psychological dis...
Objective: Evidence suggests the practice of yoga may result in
clinically significant improvements in pain and functional out-
comes in people with musculoskeletal conditions. This presen-
tation outlines the development of a pilot randomized, con-
trolled trial of yoga for people with rheumatoid arthritis in a
New Zealand population. An integrati...
Background
Some researchers think that patients with higher expectations for CAM therapies experience better outcomes and that enthusiastic providers can enhance treatment outcomes. This is in contrast to evidence suggesting conventional medical providers often reorient patient expectations to better match what providers believe to be realistic. Ho...
Conceptual model of factors influencing patient expectations.
The full text of the focus group interview guide.
(DOC)
Differences in the effectiveness of diverse healthcare providers to promote health behavior change and successful diabetes self-care have received little attention. Because training in naturopathic medicine (NM) emphasizes a patient-centered approach, health promotion, and routine use of clinical counseling on wellness and prevention, naturopathic...
Background:
Health care costs associated with use of complementary and alternative medicine (CAM) by patients with spine problems have not been studied in a national sample.
Objectives:
To estimate the total and spine-specific medical expenditures among CAM and non-CAM users with spine problems.
Research design:
Analysis of the 2002-2008 Medic...
Objectives:
Complementary and alternative medicine (CAM) providers are becoming more integrated into the United States health care system. Because patients self-select CAM use, risk adjustment is needed to make the groups more comparable when analyzing utilization. This study examined how the choice of risk adjustment method affects assessment of...
Background
Despite the growing popularity of massage, its effectiveness for treating neck pain remains unclear, largely because of the poor quality of research. A major deficiency of previous studies has been their use of low “doses” of massage that massage therapists consider inadequate. Unfortunately, the number of minutes per massage session, se...
Modern clinical-research practice favors placebo controls over usual-care controls whenever a credible placebo exists. An unrecognized consequence of this preference is that clinicians are more limited in their ability to provide the benefits of the non-specific healing effects of placebos in clinical practice.
We examined the issues in choosing be...
While previous studies focused on the effectiveness of individual complementary and alternative medical (CAM) therapies, the value of providing patients access to an integrated program involving multiple CAM and conventional therapies remains unknown. The objective of this study is to explore the feasibility and effects of a model of multidisciplin...
Dance therapy uses psychotherapeutic movement to support the cognitive, emotional, physical, and social integration of a person. Dance therapy may be of value for people with developmental, medical, social, physical, or psychological impairments.
To evaluate the hypothesis that dance therapy has therapeutic benefits by systematically analyzing and...
Chronic low back pain is a common problem lacking highly effective treatment options. Small trials suggest that yoga may have benefits for this condition. This trial was designed to determine whether yoga is more effective than conventional stretching exercises or a self-care book for primary care patients with chronic low back pain.
A total of 228...
We studied the openness of patients and clinicians to introducing a broader range of healing options into primary care.
Focus groups were conducted with primary care patients (4 groups) and clinicians (3 groups) from an integrated medical care system in 2008. Transcripts of discussions were analyzed using an immersion/crystallization approach.
Both...
Synthesis and analysis of presentation and discussion highlights, with a focus on emerging trends and promising new directions in primary care research on low back pain (LBP).
To present a summary of findings, themes, and insights from the Tenth International Forum on Primary Care Research on Low Back Pain, a meeting of researchers designed to shar...
Few studies have evaluated the effectiveness of massage for chronic low back pain.
To compare the effectiveness of 2 types of massage and usual care for chronic back pain.
Parallel-group randomized, controlled trial. Randomization was computer-generated, with centralized allocation concealment. Participants were blinded to massage type but not to a...
Preplanned secondary analysis of data from participants receiving acupuncture in a randomized clinical trial.
To determine whether patients' expectations of and preferences for acupuncture predict short and long-term treatment outcomes for persons with chronic back pain.
Although accumulating evidence suggests that patient expectations and treatmen...
Although massage is one of the most popular complementary and alternative medical (CAM) treatments for anxiety, its effectiveness has never been rigorously evaluated for a diagnosed anxiety disorder. This study evaluates the effectiveness of therapeutic massage for persons with generalized anxiety disorder (GAD).
Sixty-eight persons with GAD were r...
Back pain, one of the most prevalent conditions afflicting American adults, is the leading reason for using complementary and alternative medicine (CAM) therapies. Yoga is an increasingly popular "mind-body" CAM therapy often used for relieving back pain and several small studies have found yoga effective for this condition. This study will assess...
Objectives: To describe the federal initiative in outcomes research, the organization and structor of a Patient Outcomes Research Team [PORT] concerned with low back pain, and the early progress of this research team. Findings: Back pain is a leading reason for physician visits, hospitalization, and work disability. However, there is a paucity of v...
Meeting recruitment goals is challenging for many clinical trials conducted in primary care populations. Little is known about how the use of different recruitment strategies affects the types of individuals choosing to participate or the conclusions of the study.
A secondary analysis was performed using data from participants recruited to a clinic...
In reply
Our trial was designed to determine if adjunctive acupuncture needling was more effective than usual care alone for chronic back pain and if acupuncture involving needle insertion was more effective than simulated (noninsertive) acupuncture in clinically relevant acupuncture points.1 We found that insertive and noninsertive acupuncture had...
Chronic back pain is a major public health problem and the primary reason patients seek massage treatment. Despite the growing use of massage for chronic low back pain, there have been few studies of its effectiveness. This trial will be the first evaluation of the effectiveness of relaxation massage for chronic back pain and the first large trial...
Background
Although many clinicians believe there are clinically important subgroups of persons with "non-specific" low back pain, such subgroups have not yet been clearly identified. As part of a large trial evaluating acupuncture for chronic low back pain, we sought to identify subgroups of participants that were particularly responsive to acupun...
Acupuncture is a popular complementary and alternative treatment for chronic back pain. Recent European trials suggest similar short-term benefits from real and sham acupuncture needling. This trial addresses the importance of needle placement and skin penetration in eliciting acupuncture effects for patients with chronic low back pain.
A total of...
Little is known about the effectiveness of therapeutic massage, one of the most popular complementary medical treatments for neck pain. A randomized controlled trial was conducted to evaluate whether therapeutic massage is more beneficial than a self-care book for patients with chronic neck pain.
Sixty-four such patients were randomized to receive...
Review of oral and poster presentations and of workshop summaries from the Ninth International Forum for Primary Care Research on Low Back Pain held in Majorca, Spain, October 4-6, 2007.
Summarize highlights of the conference.
The International Forum for Primary Care Research on Low Back Pain has become the primary conference for presenting researc...
We wanted to understand the views of patients and clinicians on the central concept of healing and to identify major facilitators of and barriers to promoting healing in primary care.
We undertook a qualitative analysis of focus group discussions. Participants were drawn from primary care clinics of a large, integrated, health care system in Washin...
Few studies have evaluated the association between patient expectations for recovery and clinical outcomes, and no study has evaluated whether asking patients to choose their therapy modifies such an association.
To evaluate the association between patients' expectations and functional recovery in patients with acute low back pain (LBP), and to det...
Chronic back pain is a major public health problem and the primary reason patients seek acupuncture treatment. Therefore, an objective assessment of acupuncture efficacy is critical for making informed decisions about its appropriate role for patients with this common condition. This study addresses methodological shortcomings that have plagued pre...
A randomized controlled trial.
To investigate the effectiveness and cost of usual care plus patient choice of acupuncture, chiropractic, or massage therapy (choice) compared with usual care alone in patients with acute low back pain (LBP).
Few studies have evaluated care models with facilitated access to and financial coverage for adjunctive comple...
Since 1996, Washington State law has required that private health insurance cover licensed complementary and alternative medicine (CAM) providers.
To evaluate how insured people used CAM providers and what role this played in healthcare utilization and expenditures.
Cross-sectional analysis of insurance enrollees from western Washington in 2002.
An...
Even though complementary and alternative medicine (CAM) is generally practiced as distinct systems of medicine, almost all CAM research has focused on single therapies. In order to more adequately evaluate the effectiveness of these medical systems, studies that evaluate the outcome of intact whole systems are needed. One challenge lies in definin...
Massage therapy techniques. A list of the 36 distinct techniques that form the third level of our taxonomy.
To describe the diagnostic and therapeutic content of visits for chronic back pain to acupuncturists, chiropractors, and massage therapists.
Randomly selected acupuncturists, chiropractors, and massage therapists in two states were surveyed, and then eligible providers collected data on consecutive patient visits. The authors analyzed information o...
One of the challenges in conducting research in the field of massage and bodywork is the lack of consistent terminology for describing the treatments given by massage therapists. The objective of this study was to develop a taxonomy to describe what massage therapists actually do when giving a massage to patients with musculoskeletal pain.
After co...
Chronic low back pain is a common problem that has only modestly effective treatment options.
To determine whether yoga is more effective than conventional therapeutic exercise or a self-care book for patients with chronic low back pain.
Randomized, controlled trial.
A nonprofit, integrated health care system.
101 adults with chronic low back pain....
To describe chiropractic care using data collected at the time of each patient visit.
Random samples of chiropractors licensed in Arizona and Massachusetts were recruited to participate in interviews about their training, demographics, and practice characteristics. Interviewees were then recruited to record information about patient condition, eval...
Although up to a third of the 10,000 acupuncturists in the United States are medical doctors, little is known about the acupuncture techniques they use or how their practices compare with those of nonphysician licensed acupuncturists. This is the first study providing descriptive data on physician acupuncture and comparison to nonphysician acupunct...
Analysis of health insurance claims from 2 large Washington State companies.
To evaluate the prevalence and cost of complementary and alternative medicine (CAM) provider use for back pain treatment.
Washington State requires all commercial insurance to cover licensed CAM providers.
Outpatient claims for the treatment of back pain were analyzed by t...
Massage Care Survey. The visit form used for each of the massage therapy visits
Glossary of Selected Massage Techniques. Definitions of selected massage techniques
This study provides basic information about the training and practices of licensed acupuncturists.
Randomly selected licensed acupuncturists in Massachusetts and Washington state were interviewed and asked to record information on 20 consecutive patient visits.
Most acupuncturists in both states had 3 or 4 years of academic acupuncture training and...
Despite the growing popularity of therapeutic massage in the US, little is known about the training or practice characteristics of massage therapists. The objective of this study was to describe these characteristics.
As part of a study of random samples of complementary and alternative medicine (CAM) practitioners, we interviewed 226 massage thera...
