Clinical course of non‐specific low back pain: A systematic review of prospective cohort studies set in primary care

Itz, Coen J.; Geurts, José W.; Kleef, Maarten van; Nelemans, Patricia J.

doi:10.1002/j.1532-2149.2012.00170.x

Cited by 329 publications

(247 citation statements)

References 36 publications

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“…4 In the United Kingdom, 6% to 9% of adults consult a family physician for back pain each year, 5 accounting for 14% of consultations. 6 More than 60% still report pain and disability a year later, 7,8 and 2% to 7% will develop severe persistent symptoms 9 leading to high levels of reconsultation, work loss, and sickness certification. 10 Recent guidelines recommend Nadine E. Foster evidence-based treatments, but the optimal approaches to target resources and improve the efficiency and effectiveness of primary care remain elusive.…”

Section: Introductionmentioning

confidence: 99%

Effect of Stratified Care for Low Back Pain in Family Practice (IMPaCT Back): A Prospective Population-Based Sequential Comparison

Foster

Mullis

Hill

et al. 2014

The Annals of Family Medicine

245

292

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PURPOSE We aimed to determine the effects of implementing risk-stratified care for low back pain in family practice on physician's clinical behavior, patient outcomes, and costs. METHODSThe IMPaCT Back Study (IMplementation to improve Patient Care through Targeted treatment) prospectively compared separate patient cohorts in a preintervention phase (6 months of usual care) and a postintervention phase (12 months of stratified care) in family practice, involving 64 family physicians and linked physical therapy services. A total of 1,647 adults with low back pain were invited to participate. Stratified care entailed use of a risk stratification tool to classify patients into groups at low, medium, or high risk for persistent disability and provision of risk-matched treatment. The primary outcome was 6-month change in disability as assessed with the Roland-Morris Disability Questionnaire. Process outcomes captured physician behavior change in risk-appropriate referral to physical therapy, diagnostic tests, medication prescriptions, and sickness certifications. A cost-utility analysis estimated incremental quality-adjusted life-years and back-related health care costs. Analysis was by intention to treat. RESULTSThe 922 patients studied (368 in the preintervention phase and 554 in the postintervention phase) had comparable baseline characteristics. At 6 months follow-up, stratified care had a small but significant benefit relative to usual care as seen from a mean difference in Roland-Morris Disability Questionnaire scores of 0.7 (95% CI, 0.1-1.4), with a large, clinically important difference in the high risk group of 2.3 (95% CI, 0.8-3.9). Mean time off work was 50% shorter (4 vs 8 days, P = .03) and the proportion of patients given sickness certifications was 30% lower (9% vs 15%, P = .03) in the postintervention cohort. Health care cost savings were also observed.CONCLUSIONS Stratified care for back pain implemented in family practice leads to significant improvements in patient disability outcomes and a halving in time off work, without increasing health care costs. Wider implementation is recommended. INTRODUCTIONI t has been stated that "most cases of back pain resolve regardless of the course of therapy, and some do not get better no matter what is done. Therein lies the problem for practitioners, patients, and policy makers."1 Health care systems universally face the challenge of providing effective primary care for low back pain within constrained resources, in the face of increased demands for treatment and investigations.2,3 Back pain is now the 6th highest contributor to the global burden of disease. 4 In the United Kingdom, 6% to 9% of adults consult a family physician for back pain each year, 5 accounting for 14% of consultations. 6 More than 60% still report pain and disability a year later, 7,8 and 2% to 7% will develop severe persistent symptoms 9 leading to high levels of reconsultation, work loss, and sickness certification. 10 evidence-based treatments, but the optimal approaches to tar...

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Section: Introductionmentioning

confidence: 99%

Effect of Stratified Care for Low Back Pain in Family Practice (IMPaCT Back): A Prospective Population-Based Sequential Comparison

Foster

Mullis

Hill

et al. 2014

The Annals of Family Medicine

245

292

View full text Add to dashboard Cite

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“…1 Its natural history and patient response to existing traditional therapies are often unfavorable. 2,3 In addition, patients commonly face barriers to evidence-based pain care, such as limited availability of pain medicine specialists and specialty treatments, or inadequate insurance coverage, that further contribute to suboptimal outcomes. 1 Therefore, it is not surprising that patients with CLBP frequently turn to opioid therapy, 4 which may have limited efficacy and lead to negative effects, including overdose.…”

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confidence: 99%

Mindfulness Meditation-Based Intervention Is Feasible, Acceptable, and Safe for Chronic Low Back Pain Requiring Long-Term Daily Opioid Therapy

Zgierska

Burzinski

Cox

et al. 2016

The Journal of Alternative and Complementary Medicine

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Objective: Although mindfulness meditation (MM) is increasingly used for chronic pain treatment, limited evidence supports its clinical application for opioid-treated chronic low back pain (CLBP). The goal of this study was to determine feasibility, acceptability, and safety of an MM-based intervention in patients with CLBP requiring daily opioid therapy. Design: 26-week pilot randomized controlled trial comparing MM-based intervention, combined with usual care, to usual care alone. Setting: Outpatient. Patients: Adults with CLBP treated with ‡30 mg of morphine-equivalent dose (MED) per day for 3 months or longer. Interventions: Targeted MM-based intervention consisted of eight weekly 2-hour group sessions and home practice (30 minutes/d, 6 days/wk) during the study. ''Usual care'' for opioid-treated CLBP was provided to participants by their regular clinicians. Outcome measures: Feasibility and acceptability of the MM intervention were assessed by adherence to intervention protocol and treatment satisfaction among experimental participants. Safety was evaluated by inquiry about side effects/adverse events and opioid dose among all study participants. Results: Thirty-five participants enrolled during the 10-week recruitment period. The mean age (-standard deviation) was 51.8 -9.7 years; the patients were predominantly female, with substantial CLBP-related pain and disability, and treated with 148.3 -129.2 mg of MED per day. All participants completed baseline assessments; none missed both follow-up assessments or withdrew. Among experimental participants (n = 21), 19 attended 1 or more intervention sessions and 14 attended 4 or more. They reported, on average, 164.0 -122.1 minutes of formal practice per week during the 26-week study and 103.5 -111.5 minutes of brief, informal practice per week. Seventeen patients evaluated the intervention, indicating satisfaction; their qualitative responses described the course as useful for pain management (n = 10) and for improving pain coping skills (n = 8). No serious adverse events or safety concerns occurred among the study participants. Conclusions: MM-based intervention is feasible, acceptable, and safe in opioid-treated CLBP.

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“…Twenty to thirty percent of people with acute musculoskeletal pain go on to develop chronic pain that persists after normal tissue healing time and is not associated with tissue inflammation (24,26,30). Further, a single bout of exercise in people with existing acute inflammatory and chronic noninflammatory pain conditions enhances ongoing pain and hyperalgesia (27,59,61).…”

mentioning

confidence: 99%

Regular physical activity prevents development of chronic pain and activation of central neurons

Sluka

O’Donnell

Danielson

et al. 2013

Journal of Applied Physiology

167

168

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Clinical course of non‐specific low back pain: A systematic review of prospective cohort studies set in primary care

Abstract: The findings of this review indicate that the assumption that spontaneous recovery occurs in a large majority of patients is not justified. There should be more focus on intensive follow-up of patients who have not recovered within the first 3 months.

Cited by 329 publications

References 36 publications

Effect of Stratified Care for Low Back Pain in Family Practice (IMPaCT Back): A Prospective Population-Based Sequential Comparison

Effect of Stratified Care for Low Back Pain in Family Practice (IMPaCT Back): A Prospective Population-Based Sequential Comparison

Mindfulness Meditation-Based Intervention Is Feasible, Acceptable, and Safe for Chronic Low Back Pain Requiring Long-Term Daily Opioid Therapy

Regular physical activity prevents development of chronic pain and activation of central neurons

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