Brief psychosocial education, not core stabilization, reduced incidence of low back pain: results from the Prevention of Low Back Pain in the Military (POLM) cluster randomized trial

George, Steven Z.; Childs, John D.; Teyhen, Deydre S.; Wu, Samuel S.; Wright, Alison C.; Dugan, Jessica L.; Robinson, Michael E.

doi:10.1186/1741-7015-9-128

Cited by 70 publications

(56 citation statements)

References 43 publications

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“…However, implementing screening measures based on psychosocial factors may help guide practice in physical therapy treatment. These efforts may then be further extended to improve treatment of low back pain in different patient populations at risk for developing chronic pain with concomitant psychosocial factors, such as those in military settings (14,60). …”

Section: Discussionmentioning

confidence: 99%

The Role of Anger in Psychosocial Subgrouping for Patients With Low Back Pain

Nisenzon¹,

George²,

Beneciuk³

et al. 2014

The Clinical Journal of Pain

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Low back pain (LBP) is a common and costly condition that often becomes chronic if not properly addressed. Recent research has shown that psychosocial symptoms can complicate LBP, necessitating more comprehensive screening measures. The present study investigated the role of psychosocial factors, including anger regulation, in pain and disability using a screening measure designed for LBP treated with physical therapy. One-hundred and three LBP patients initiating physical therapy completed an established screening measure to assess risk for developing chronic pain, as well as psychosocial measures assessing anger, depression, anxiety, fear-avoidance, and pain-catastrophizing before and after four weeks of treatment. Dependent variables were pain intensity, physical impairment, and patient-reported disability. Risk subgrouping based on anger and other psychosocial measures was examined using established screening methods and through employing an empirical statistical approach. Analyses revealed that risk subgroups differed according to corresponding levels of negative affect, as opposed to anger alone. General psychosocial distress also predicted disability post-treatment, but, interestingly, did not have a strong relationship to pain. Subsequent hierarchical agglomerative clustering procedures divided patients into overall High and Low Distress groups, with follow-up analyses revealing that the High Distress group had higher baseline measures of pain, disability, and impairment. Findings suggest that anger may be part of generalized negative affect rather than a unique predictor when assessing risk for pain and disability in LBP treatment. Continued research in the area of screening for psychosocial prognostic indicators in LBP may ultimately guide treatment protocols in physical therapy for more comprehensive patient care.

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Section: Discussionmentioning

confidence: 99%

The Role of Anger in Psychosocial Subgrouping for Patients With Low Back Pain

Nisenzon¹,

George²,

Beneciuk³

et al. 2014

The Clinical Journal of Pain

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“…POLM trial results indicated that psychosocial education was found to be preventative of seeking healthcare for LBP [17]. This study reports on a secondary aim of the POLM trial which was to determine what factors were predictive of self-reported LBP for Soldiers that responded to a web-based or phone survey tools.…”

Section: Methodsmentioning

confidence: 99%

Predictors of Occurrence and Severity of First Time Low Back Pain Episodes: Findings from a Military Inception Cohort

et al. 2012

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Primary prevention studies suggest that additional research on identifying risk factors predictive of low back pain (LBP) is necessary before additional interventions can be developed. In the current study we assembled a large military cohort that was initially free of LBP and followed over 2 years. The purposes of this study were to identify baseline variables from demographic, socioeconomic, general health, and psychological domains that were predictive of a) occurrence; b) time; and c) severity for first episode of self-reported LBP. Baseline and outcome measures were collected via web-based surveillance system or phone to capture monthly information over 2 years. The assembled cohort consisted of 1230 Soldiers who provided self-report data with 518 (42.1%) reporting at least one episode of LBP over 2 years. Multivariate logistic regression analysis indicated that gender, active duty status, mental and physical health scores were significant predictors of LBP. Cox regression revealed that the time to first episode of LBP was significantly shorter for Soldiers that were female, active duty, reported previous injury, and had increased BMI. Multivariate linear regression analysis investigated severity of the first episode by identifying baseline predictors of pain intensity, disability, and psychological distress. Education level and physical fitness were consistent predictors of pain intensity, while gender, smoking status, and previous injury status were predictors of disability. Gender, smoking status, physical health scores, and beliefs of back pain were consistent predictors of psychological distress. These results provide additional data to confirm the multi-factorial nature of LBP and suggest future preventative interventions focus on multi-modal approaches that target modifiable risk factors specific to the population of interest.

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“…The Personalized Psychological Education interventions follow what has been used in low back pain clinical trials [65–68] and key principles in psychologically informed interventions [69]. These principles are not specific to the anatomical region of pain, for example there is a clinical trial of cognitive behavioral treatment for reducing catastrophizing in individuals with chronic headache [70].…”

Section: Methodsmentioning

confidence: 99%

Biopsychosocial influence on shoulder pain: Rationale and protocol for a pre-clinical trial

George

Staud

Borsa

et al. 2017

Contemporary Clinical Trials

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Background Chronic musculoskeletal pain conditions are a prevalent and disabling problem. Preventing chronic musculoskeletal pain requires multifactorial treatment approaches that address its complex etiology. Prior cohort studies identified a high risk subgroup comprised of variation in COMT genotype and pain catastrophizing. This subgroup had increased chance of heightened pain responses (in a pre-clinical model) and higher 12 month post-operatives pain intensity ratings (in a clinical model). This pre-clinical trial will test mechanisms and efficacy of personalized pain interventions matched to the genetic and psychological characteristics of the high-risk subgroup. Methods Potential participants will be screened for high risk subgroup membership, appropriateness for exercise-induced muscle injury protocol, and appropriateness for propranolol administration. Eligible participants that consent to the study will then be randomized into one of four treatment groups; 1) personalized pharmaceutical and psychological education; 2) personalized pharmaceutical and general education; 3) placebo pharmaceutical and psychological education; 4) placebo pharmaceutical and psychological education. Over the 5-day study period participants will complete an exercise-induced muscle injury protocol and receive study interventions. Pain and disability assessments will be completed daily, with primary outcomes being duration of shoulder pain (number of days until recovery), peak shoulder pain intensity, and peak shoulder disability. Secondary outcomes include inflammatory markers, psychological mediators, and measures of pain sensitivity regulation. Conclusion This pre-clinical trial builds on prior cohort studies and its completion will provide foundational data supporting efficacy and mechanisms of personalized interventions for individuals that may be at increased risk for developing chronic shoulder pain. Trial Registration ClinicalTrials.gov registry, NCT02620579 (Registered on November 13, 2015)

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Brief psychosocial education, not core stabilization, reduced incidence of low back pain: results from the Prevention of Low Back Pain in the Military (POLM) cluster randomized trial

Cited by 70 publications

References 43 publications

The Role of Anger in Psychosocial Subgrouping for Patients With Low Back Pain

The Role of Anger in Psychosocial Subgrouping for Patients With Low Back Pain

Predictors of Occurrence and Severity of First Time Low Back Pain Episodes: Findings from a Military Inception Cohort

Biopsychosocial influence on shoulder pain: Rationale and protocol for a pre-clinical trial

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