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Selasa, 22 Januari 2008

[Supertraining] Multidisciplinary Treatment May Benefit Patients With Chronic Low Back Pain

This may be of interest to list members engaged in information exchanges
related to CLBP.

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.

Sebastian Scoles wrote:
> The hypothesis that low back pain is of psychosocial cause
> exclusively, has any scientific foundation?
> The evidence shows that in fact, LBP has psychosocial implications.
> Chronic pain is associated with more incidence of depression (Kothe
> et al 2007; Sullivan et al 1992; )and anxiety disorder (Demyttenaere
> et al 2007; Lachlan et al 2004).
> Psychological disturbances are one of the consequences of any kind
> of chronic pain, but not its cause (Gamsa 1990, Gamsa and Freibergs
> 1991). Some studies even show that those psychological disturbances
> disappear after the chronic pain resolution (Wallis et al 1997).
> References:
> *Kothe R, Kohlmann TH, Klink T, Ruther W, Klinger R (2007):" Impact
> of low back pain on functional limitations, depressed mood and
> quality of life in patients with rehumatoid arthritis" PAIN 127(1-
> 2):103-108
> *Sullivan M, Renor K, Mikail S, Fisher R (1992):"The treatment of
> depression in chronic low back pain" PAIN 50(1):5-13
> *Demyttenaere K, et al(2007):"Mental disorders among persons with
> chronic back pain" PAIN 129(3):332-342
> *Gamsa A (1990):"Is emotional disturbance a precipitator or a
> consequence of chronic pain?" PAIN. Aug; 42(2):183-95
> *Gamsa A and Freibergs V (1991):"Psychological events are both
> risks factors in, and consequence of, chronic pain" PAIN. Mar; 44
> (3):271-7
> Sebastián Scoles
> Buenos Aires, Argentina
> ----------------------------------------------------------
> Internal Virus Database is out-of-date.
> Checked by AVG Free Edition.
> Version: 7.1.361 / Virus Database: 267.12.4/146 - Release Date: 21/10/2005

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