Defining Patient-Centered, Multidimensional Success Criteria for Treatment of Chronic Spine Pain

Brown, Jennifer L.; Edwards, Penny S.; Atchison, James W.; Lafayette-Lucey, Ann; Wittmer, V.; Robinson, Michael E.

doi:10.1111/j.1526-4637.2007.00357.x

Cited by 47 publications

(45 citation statements)

References 15 publications

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“…Patients’ success criteria were shown to require a larger reduction in pain, distress, and fatigue than originally hypothesized, though patients did not expect to reach their own success criteria for the level of interference domain 5. Similarly, research has shown that, to consider treatment for pain successful, patients’ criteria for treatment outcome are relatively high compared with health care professionals’ criteria 6,7…”

Section: Introductionmentioning

confidence: 90%

Investigating patient expectations and treatment outcome in a chronic low back pain population

Sanderson¹,

Roditi²,

George³

et al. 2012

JPR

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ObjectiveThis study aimed to measure the outcomes that patients consider clinically meaningful across four treatment domains – (1) pain, (2) fatigue, (3) emotional distress, and (4) level of interference – and determine if patients met their own success criteria. Additionally, the role of expectations in treatment outcome was examined. This study also aimed to determine how change in levels of pain, fatigue, disability, and level of interference varied according to the type of treatment delivered to participants.PatientsForty-seven chronic low back pain patients were recruited from university-affiliated pain clinics.DesignThe study design was longitudinal, consisting of two randomly assigned treatment conditions. The first treatment condition used opioid medication only and the second used both opioid medication and brief cognitive behavioral therapy. Pre- and post-treatment assessments were conducted, which occurred approximately 3 months after the initiation of treatment.Outcome measuresA patient-centered outcomes questionnaire was completed by participants at both pre- and post-treatment assessment.ResultsResults suggest that patients did not meet their own success criteria in treatment across any of the four domains. There was a significant main effect of time for level of pain indicating that both treatment groups had a decrease in their level of pain at post-treatment, F(1, 45) = 11.98, P < 0.001. There was a significant main effect of time for level of interference domain indicating that both groups experienced a reduction in the level of pain-related interference with daily activities, F(1, 45) = 5.46, P < 0.05. There were no significant effects of time for emotional distress or fatigue or any significant group by time interactions. Contrary to our hypothesis, no significant correlations were found between pretreatment expectations and usual level ratings at post-treatment across the four domains.ConclusionPatients sought larger reductions in pain, fatigue, level of distress, and level of interference than they attained at post-treatment. Enhancing opioid treatment with brief cognitive behavioral therapy did not yield additional improvements for the four domains assessed in patients with chronic low back pain.

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Section: Introductionmentioning

confidence: 90%

Investigating patient expectations and treatment outcome in a chronic low back pain population

Sanderson¹,

Roditi²,

George³

et al. 2012

JPR

Self Cite

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“…81 Most of these also suffer from a list of chronic psychosocial problems. [82][83][84] These in turn interfere with the outcome of treatment. 85 Negative beliefs about pain 86 and depression 87 seem to be predictors of higher levels of disability.…”

Section: Other Issues More Important Than the Causes Of Back Pain?mentioning

confidence: 97%

The Diagnosis of the Origins of Spinal Pain: Implications for the Spinal Surgeon

Seres

2009

Neurosurgery Quarterly

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Surgery for common spinal disorders has changed dramatically in the last several decades. The failed surgical back syndrome patients populate a vast number of chronic pain clinics and rehabilitation facilities. New surgical procedures promise better outcomes. Yet documented improvement in imaging studies and the original promise of newer technologies have not consistently resulted in better clinical outcomes. More important than the technical success is the improved state of the patient. The search for the ''properly selected patient'' is a commonly used euphemism to explain away less ideal outcomes. Yet the phrase continues without clear specificity. The study is a review of some of the problems in planning the surgical care for the spinal patient. Spinal surgeons generally do not follow their patients after surgery long enough to fully comprehend the results and the impacts of their procedures, especially as viewed by the patient. We present an alternative approach that reduces the role of the spinal surgeon by encouraging more input from those who are likely to follow the patient who might not fare well. Experience in the treatment of surgical failures educates these practitioners to provide an evidence-based approach to surgical indications not as readily available to the spinal surgeon in many modern surgical practices.

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“…Individuals with NP regard reduced fatigue, secondary to pain relief, as the most important indicator of treatment success (Brown et al, 2008; Robinson et al, 2005). Although it is estimated that up to 55% of persons with chronic pain experience fatigue, it is a symptom that often receives little attention in clinical practice (Mota & Pimenta, 2006).…”

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confidence: 99%

Psychologic and Biologic Factors Associated with Fatigue in Patients with Persistent Radiculopathy

Starkweather

2013

Pain Management Nursing

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Fatigue is a common symptom associated with neuropathic pain (NP) and can have negative consequences on psychosocial functioning, physical endurance, and quality of life. Recent evidence indicates that immune activation modulated through the increased release of proinflammatory cytokines can predict fatigue in some patient populations. Although earlier studies have shown that immune activation is a pathophysiologic feature of NP, there have been no studies to examine the relationship between immune activation and fatigue in persons with NP. Therefore, the purpose of this exploratory study was to: 1) determine the relationships among fatigue, pain, psychosocial factors, and selected biologic markers of immune activation (interleukin [IL] 6 and soluble IL-6 receptor [sIL-6R]) in participants with persistent radiculopathy; and 2) determine the differences in these variables based on fatigue severity. Participants (n = 80) were classified according to their level of fatigue as low (27.5%), moderate (32.5%), or high (40%), and significant differences were found between fatigue categories (p =.001). Multivariate analyses of variance revealed that individuals with moderate to high levels of fatigue differed from those with the lowest levels of fatigue in psychologic distress, depressive symptoms, IL-6, and sIL-6R, whereas the differences between moderate and high levels of fatigue were significant for psychologic distress and sIL-6R only. The findings suggest that immune activation affects fatigue severity and possibly other behavioral responses, offering important information when providing care to patients with persistent radiculopathy. The integration of biobehavioral nursing interventions in pain management may have a greater impact on quality of life than treatment focused only on pain.

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Defining Patient-Centered, Multidimensional Success Criteria for Treatment of Chronic Spine Pain

Cited by 47 publications

References 15 publications

Investigating patient expectations and treatment outcome in a chronic low back pain population

Investigating patient expectations and treatment outcome in a chronic low back pain population

The Diagnosis of the Origins of Spinal Pain: Implications for the Spinal Surgeon

Psychologic and Biologic Factors Associated with Fatigue in Patients with Persistent Radiculopathy

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