Intensive interdisciplinary outpatient pain management program for chronic back pain: a pilot study

Abstract

BackgroundChronic back pain is relatively resistant to unimodal therapy regimes. The aim of this study was to introduce and evaluate the short-term outcome of a three-week intensive multidisciplinary outpatient program for patients with back pain and sciatica, measured according to decrease of functional impairment and pain.MethodsThe program was designed for patients suffering from chronic back pain to provide intensive interdisciplinary therapy in an outpatient setting, consisting of interventional injection techniques, medication, exercise therapy, back education, ergotherapy, traction, massage therapy, medical training, transcutaneous electrical nerve stimulation, aquatraining, and relaxation.ResultsBased on Oswestry Disability Index (ODI) and Numeric Rating Scale (NRS) scores, a significant improvement in pain intensity and functionality of 66.83% NRS and an ODI of 33.33% were achieved by our pain program within 3 weeks.ConclusionThis paper describes the organization and short-term outcome of an intensive multidisciplinary program for chronic back pain on an outpatient basis provided by our orthopedic department, with clinically significant results.

The effects of educational interventions on pharmacists’ knowledge, attitudes and beliefs towards low back pain

“…However, there are some reports which highlight a need for strengthened collaboration between pharmacists and prescribers, in order to [44]. Increasingly, evidence around chronic back pain management support a patient-centered approach to care within a multidisciplinary framework, as it is unlikely complex cases can be adequately managed by a single HCP acting independently [45].…”

Multidisciplinary pain management programs

“…Artner et al analyzed the short-term outcome of a 3-week intensive multidisciplinary outpatient program for patients suffering from back pain and sciatica retrospectively 10. The intensive treatment consisted of interventional injection techniques (eg, epidural, periradicular and facet joint injections) with a frequency of up to 8 injections per patient and additional multiple treatment approaches such as modification of analgesic medication, ergotherapy, massage therapy, back education, transcutaneous electrical nerve stimulation and aquatraining.…”

“…However it was used with increased frequency over the time period observed. Baseline and outcome parameters were assessed using only the Numeric Rating Scale (NRS) and Oswestry Disability Index (ODI) 10. They concluded that the short-term results of their treatment program were clinically significant in improving pain as well as in functionality.…”

“…The therapy program is defined differently throughout the paper (intensive interdisciplinary therapy versus special orthopedic pain management program versus conservative treatment), which is problematic as it remains unclear, what Artner et al regards as the fundamental basis of their treatment program 10. One major limitation includes the lack of implementation of minimal standards in multimodal pain therapy as defined by a special working group of the German chapter of the International Association for the Study of Pain (IASP) 8…”

“…According to the principles of functional restoration it is recommended to use activating methods and avoid passive ones. Spinal and facet joint injections seemed to be the one essential part of the treatment regimen 10. This is surprising, as Staal et al already noticed that there is insufficient scientific evidence on the effects of injection therapy, regardless of type and dosage, for patients with subacute and chronic low-back pain 11.…”