Examination of the Course of Low Back Pain Intensity Based on Baseline Predictors and Health Care Utilization Among Patients Treated in Multidisciplinary Pain Clinics: A Quebec Pain Registry Study

Abstract

Objectives: The study objectives were to identify baseline predictors of low back pain severity changes over a one-year period among patients attending multidisciplinary tertiary clinics and determine whether health care utilization impacts on this outcome.Methods: This is a retrospective cohort study using the Quebec Pain Registry (QPR). A total of 686 low back pain (LBP) patients (55.8% females; mean age = 56.51±14.5 years) from the QPR were selected for this study. Patients completed self-report questionnaires and nurse-administered questionnaires before their first appointment at a multidisciplinary pain treatment center. Analysis was conducted using linear growth model.Results: There was a modest (10%) improvement in pain severity scores over a 12month period. Pain catastrophizing and depressive symptoms predicted higher baseline levels of pain severity (p < 0.001)Having used self-management approaches over the past 6 months was associated with higher levels of pain severity at 12 months (p < 0.001).Discussion: Results from this study showed no clear pattern of association between the use of different treatment disciplines and pain severiy over the first year following multidisciplinary treatment intervention. These results raise an important question as to the best way of utilizing scarce multidisciplinary resources to optimize cost-effectiveness and improve outcomes among complex, chronic LBP patients.

The Relationship between Cognitive and Emotional Factors and Healthcare and Medication Use in People Experiencing Pain: A Systematic Review

“…However, for depressive symptoms, multivariate analyses indicated the absence of an association with opioid use (2 analyses showing a positive association [ 86 , 101 ] and 4 no association [ 62 , 86 , 101 , 121 ]—33%). Moreover, no evidence was found for a relationship between depressive symptoms and prescription pain medication use (univariate: 2 analyses showing a positive association [ 48 , 76 ] and 16 no association [ 48 , 49 ]—11%), OTC pain medication use (univariate: 1 analyses showing a positive association [ 48 ] and 4 no association [ 48 , 49 ]—20%), having primary care consultation (univariate: 2 analyses showing a positive association [ 112 ] and 5 no association [ 48 , 104 ]—29%), undergoing invasive procedures (univariate: 1 analysis showing a positive association [ 48 ] and 4 no association [ 48 , 131 ]—20%) and using CAM services (univariate: 6 analyses showing a positive association [ 48 , 73 , 115 ] and 23 no association [ 48 , 73 , 77 , 112 ]—21%; multivariate: 5 analyses showing no association [ 73 , 115 ]—0%) in people with pain.…”

“…Cont. Gil (2004) [102] 1 1 1 NA 1 1 1 0 0 0 0 NA NA NA 1 1 1 NA 1 1 NA NA NA NA 1 1 0 13/18 Hadlandsmyth (2013) [103] 1 1 1 NA 0 1 1 1 1 0 0 NA NA NA 1 0 1 NA 1 1 NA NA NA NA 0 0 0 11 /18 Jordan (2006) [104] 1 1 1 NA 1 1 1 0 0 1 0 NA NA NA 1 1 1 NA 1 0 NA NA NA NA 1 0 0 12/18 Keeley (2008) [105] 1 1 1 NA 1 1 1 0 1 1 0 NA NA NA 1 0 1 NA 1 1 NA NA NA NA 1 0 0 13/18 Kuijper (2014) [106] 1 1 NA 1 1 1 0 1 1 0 NA NA NA 1 0 1 NA 1 1 NA NA NA NA 1 1 0 16/18 Lentz (2018) [107] 1 1 1 NA 1 1 1 1 1 1 1 NA NA NA 1 0 1 NA 1 1 NA NA NA NA 1 1 1 17/18 Levenson (2008) [108] 1 1 1 NA 1 1 1 1 1 0 0 NA NA NA 1 0 1 NA 1 1 NA NA NA NA 1 0 0 13/18 McCracken (2005; Pain) [109] 1 1 1 NA 1 1 1 1 0 1 1 NA NA NA 0 0 1 NA 1 1 NA NA NA NA 1 0 0 13/18 Musey (2018) [110] 1 1 1 NA 1 1 1 0 1 0 0 NA NA NA 1 0 1 NA 1 0 NA NA NA NA 1 0 1 12/18 Navabi (2018) [111] 1 1 1 NA 1 1 1 0 0 1 0 NA NA NA 1 0 1 NA 1 0 NA NA NA NA 1 0 0 11/18 Pagé (2019) [112] 0 1 1 NA 1 1 1 0 1 1 1 NA NA NA 0 0 1 NA 1 1 NA NA NA NA 1 0 0 12/18 Tremblay (2018) [113] 1 1 1 NA 1 1 1 1 1 1 0 NA NA NA 1 0 1 NA 1 1 NA NA NA NA 1 0 0 14/18 Ullrich (2013) [114] 1 1 1 NA 1 1 1 0 0 1 1 NA NA NA 1 0 1 NA 1 0 NA NA NA NA 1 0 0 12/18 Van Tilburg (2008) [115] 1 1 1 NA 1 1 1 0 0 1 1 NA NA NA 1 0 1 NA 1 1 NA NA NA NA 1 0 0 12/18 Vervoort (2019) [116] 1 1 1 NA 1 1 1 1 1 1 0 NA NA NA 1 0 1 NA 1 1 NA NA NA NA 1 1 0 15/18 Williams (2018) [117] 1 1 1 NA 1 1 1 0 1 1 0 NA NA NA 1 0 1 NA 0 1 NA NA NA NA 1 0 0 12/18 Wong (2019) [118] 1 0 1 NA 1 1 0 0 0 1 0 NA NA NA 1 0 1 NA 1 1 NA NA NA NA 0 1 0 10/18 Woodhouse (2016) [119] 1 1 1 NA 1 1 1 0 1 1 0 NA NA NA 1 0 1 NA 1 1 NA NA NA NA 1 0 0 13/18…”

“… → ANCOVA Osborne (2007) [ 129 ] AU C Patients w/ chronic osteoarthritis who follow the Arthritis Self-Management Course 452 19/81 62.8 ± 12.4 y Assessed at baseline (before treatment) and 6 m after treatment Self-efficacy beliefs Pain and fatigue self-efficacy → 4 items from the original 8-item Stanford Scale (overall score based on the mean of the 4 items) → Dichotomized to positive self-efficacy change vs. negative or no change Patient-reported Retrospective (past 6 m; assessed at baseline (before treatment) and 6 m after treatment) - Number of doctor visits (amount; consultations) - Number of PT visits (amount; consultations) - Number of CAM visits (amount; CAM use) - Number of hospital admissions (amount; hospitalizations) - Length of hospital stay (amount; hospitalizations) → Dichotomous variables created for each of the above: >median number of uses vs. less To investigate whether having an above median use of the listed healthcare services (reference: lower than median use) was influencing the likelihood of having a positive change in self-efficacy at 6 m post-treatment (reference: negative or no change) while also accounting for age, sex, education level, course attendance, baseline self-efficacy and baseline use of the respective HCU outcome. → Logistic regression Pagé (2019) [ 112 ] CA C Patients w/ chronic low back pain who follow a multidisciplinary pain treatment Mean pain duration: 7.7 ± 9.2 y Median pain duration: 4 y 686 44.2/55.8 56.5 ± 14.5 y Assessed at baseline and 6 and 12 m after treatment initiation Depressive symptoms → Beck Depression Inventory Patient-reported Retrospective (assessed at 6 and 12 m after treatment initiation for the previous 6 m) Use of any of these treatments: - Psychological treatment (psychotherapy or group therapy) (type; primary care consultations) - Self-management (relaxation, meditation, hypnosis, visualization, distraction, self-help group) (type; CAM use) → yes/no for both To compare level of depressive symptoms between patients using psychological treatment and those who do not and between those who use self-management modalities and those who do not at 6 and 12 m after treatment initiatio...…”

“… <4 OTC pain medication Alschuler [ 48 ]: 1 Alschuler [ 48 ]: 3 Asmundson [ 49 ] c : 1 00 1/5 20% Asmundson [ 49 ] c : 1 ? <4 Opioids Buse [ 94 ]: 3 Carroll [ 96 ] c : 1 Huffman [ 121 ] c : 1 Jensen [ 122 ] c : 1 Vina [ 86 ]: 2 Harden [ 130 ] c : 1 Kapoor [ 61 ]: 1 Newman [ 74 ] c : 1 ++ 8/11 73% Gebauer [ 101 ] c : 1 Vina [ 86 ]: 1 Gebauer [ 101 ] c : 1 Huffman [ 121 ] c : 1 Kratz [ 62 ]: 1 Vina [ 86 ]: 1 0 2/6 33% Primary care consultations Pagé [ 112 ]: 2 Alschuler [ 48 ]: 4 Jordan [ …”

“… <4 Cronin [ 52 ]: 1 ? <4 CAM Alschuler [ 48 ]: 3 Ndao-Brumblay [ 73 ] c : 2 van Tilburg [ 115 ]: 1 Alschuler [ 48 ]: 18 Ndao-Brumblay [ 73 ] c : 2 Pagé [ 112 ]: 2 Rosenberg [ 77 ]: 1 00 6/29 21% Ndao-Brumblay [ 73 ] c : 4 van Tilburg [ 115 ]: 1 0 0/5 0% Fear-avoidance beliefs Consultations Mannion [ 68 ]: 2 ? <4 Mannion [ 68 ]: 1 Mannion [ 68 ]: 1 ?…”