Domains of Chronic Low Back Pain and Assessing Treatment Effectiveness: A Clinical Perspective

Abstract

Nonspecific chronic low back pain (CLBP) is a common clinical condition that has impacts at both the individual and societal level. Pain intensity is a primary outcome used in clinical practice to quantify the severity of CLBP and the efficacy of its treatment; however, pain is a subjective experience that is impacted by a multitude of factors. Moreover, differences in effect sizes for pain intensity are not observed between common conservative treatments, such as spinal manipulative therapy, cognitive behavioral therapy, acupuncture, and exercise training. As pain science evolves, the biopsychosocial model is gaining interest in its application for CLBP management. The aim of this article is to discuss our current scientific understanding of pain and present why additional factors should be considered in conservative CLBP management. In addition to pain intensity, we recommend that clinicians should consider assessing the multidimensional nature of CLBP by including physical (disability, muscular strength and endurance, performance in activities of daily living, and body composition), psychological (kinesiophobia, fear‐avoidance, pain catastrophizing, pain self‐efficacy, depression, anxiety, and sleep quality), social (social functioning and work absenteeism), and health‐related quality‐of‐life measures, depending on what is deemed relevant for each individual. This review also provides practical recommendations to clinicians for the assessment of outcomes beyond pain intensity, including information on how large a change must be for it to be considered “real” in an individual patient. This information can guide treatment selection when working with an individual with CLBP.

<p>Psychosocial Correlates of Objective, Performance-Based, and Patient-Reported Physical Function Among Patients with Heterogeneous Chronic Pain</p>

“…19,20 Currently, only 2 published papers looked at all 3 physical function measures within 1 study and found support for an association between PROs and performance-based function but little or no support for associations with step-count. 21,22 Treatments aimed at improving physical function in chronic pain typically target psychosocial factors such as pain, coping, and social-emotional factors, [23][24][25] which are associated with improvement in PROs. 8,26 However, it is unclear whether targeting these constructs also improves performance-based and objective/ambulatory-measured physical function, as prior studies found mixed results for associations with performance-based physical function 21,27,28 and step-count physical function.…”

Lumbar Degenerative Disease Part 1: Anatomy and Pathophysiology of Intervertebral Discogenic Pain and Radiofrequency Ablation of Basivertebral and Sinuvertebral Nerve Treatment for Chronic Discogenic Back Pain: A Prospective Case Series and Review of Literature

“…However, in terms of years lived with disability burden pattern there is similar pattern in 1990 to 2010 with lower back pain being most likely cause of musculoskeletal disability [1]. Various biopsychosocial factors lead to disability in chronic back pain [13,14]. Degenerative disc disease is a leading cause of lower back pain on a global scale [15].…”

Better muscle strength can decrease the risk of arthralgia and back &joint stiffness in Kurdish men; a cross-sectional study using data from RaNCD cohort study

“…One of the most common musculoskeletal problems is low back pain, which affects people's quality of life [1]. Non-specific low back pain is the main cause of back pain; however; low back pain is usually caused by disc herniation, lumbar stenosis, trauma, muscle strain, lumbar spondylosis, spine and kidney infections, certain cancers, endometriosis, arthritis, and ankylosing spondylitis [2,3].…”