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Low Back Pain: Recent Advances And Perspectives
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Low Back Pain: Recent Advances And Perspectives

A special issue of Healthcare (ISSN 2227-9032).

Deadline for manuscript submissions: closed (28 February 2016) | Viewed by 151110

Printed Edition Available!
A printed edition of this Special Issue is available here.

Special Issue Editor

Prof. Dr. Robert J. Gatchel

E-Mail Website
Guest Editor
Department of Psychology, College of Science, University of Texas at Arlington, Arlington, TX 76019, USA
Interests: pain management; biopsychosocial research; clinical health psychology
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Dear Colleagues,

The prevalence of chronic pain is greater than the total number of individuals in the U.S. with diabetes, heart disease, and cancer combined. Musculoskeletal pain is the most common single type of chronic pain; chronic low back pain is the most prevalent in this category, and is one of the major health problems in the U.S. With these statistics in mind, a Special Issue of Healthcare is warranted in order to update many of the recent advances and perspectives of this health problem. A number of topics will be covered: prevalence and epidemiological data; the biopsychosocial perspective of pain, which is now the most heuristic model embrace by clinical researchers; assessment and treatment approaches; and important psychosocial mediators/moderators, such as coping skills, fear avoidance, etc.

Prof. Dr. Robert J. Gatchel
Guest Editor

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Keywords

  • low back pain
  • prevalence
  • biopsychosocial model
  • psychosocial mediators/moderators

Published Papers (18 papers)

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Research

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2239 KiB  
Article
Associations between Trunk Extension Endurance and Isolated Lumbar Extension Strength in Both Asymptomatic Participants and Those with Chronic Low Back Pain
by Rebecca Conway, Jessica Behennah, James Fisher, Neil Osborne and James Steele
Healthcare 2016, 4(3), 70; https://doi.org/10.3390/healthcare4030070 - 19 Sep 2016
Cited by 26 | Viewed by 9679
Abstract
Background: Strength and endurance tests are important for both clinical practice and research due to the key role they play in musculoskeletal function. In particular, deconditioning of the lumbar extensor musculature has been associated with low back pain (LBP). Due to the relationship [...] Read more.
Background: Strength and endurance tests are important for both clinical practice and research due to the key role they play in musculoskeletal function. In particular, deconditioning of the lumbar extensor musculature has been associated with low back pain (LBP). Due to the relationship between strength and absolute endurance, it is possible that trunk extension (TEX) endurance tests could provide a proxy measure of isolated lumbar extension (ILEX) strength and thus represent a simple, practical alternative to ILEX measurements. Though, the comparability of TEX endurance and ILEX strength is presently unclear and so the aim of the present study was to examine this relationship. Methods: Thirty eight healthy participants and nineteen participants with non-specific chronic LBP and no previous lumbar surgery participated in this cross-sectional study design. TEX endurance was measured using the Biering–Sorensen test. A maximal ILEX strength test was performed on the MedX lumbar-extension machine. Results: A Pearson’s correlation revealed no relationship between TEX endurance and ILEX strength in the combined group (r = 0.035, p = 0.793), the chronic LBP group (r = 0.120, p = 0.623) or the asymptomatic group (r = −0.060, p = 0.720). Conclusions: The results suggest that TEX is not a good indicator of ILEX and cannot be used to infer results regarding ILEX strength. However, a combination of TEX and ILEX interpreted together likely offers the greatest and most comprehensive information regarding lumbo-pelvic function during extension. Full article
(This article belongs to the Special Issue Low Back Pain: Recent Advances And Perspectives)
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Article
Biopsychosocial Characteristics, Using a New Functional Measure of Balance, of an Elderly Population with CLBP
by Ryan Hulla, Michael Moomey, Tyler Garner, Christopher Ray and Robert J. Gatchel
Healthcare 2016, 4(3), 59; https://doi.org/10.3390/healthcare4030059 - 23 Aug 2016
Cited by 8 | Viewed by 5561
Abstract
This study examined the biopsychosocial characteristics of chronic low back pain (CLBP) in an understudied but increasingly larger part of the population: the elderly (i.e., 65 years and older). A new innovative physical functioning measure (postural control, which is a proxy for the [...] Read more.
This study examined the biopsychosocial characteristics of chronic low back pain (CLBP) in an understudied but increasingly larger part of the population: the elderly (i.e., 65 years and older). A new innovative physical functioning measure (postural control, which is a proxy for the common problem of slips and falls in the elderly) was part of this biopsychosocial evaluation. Also, the National Institutes of Health (NIH)-developed Patient-Reported Outcome Measurement Information System (PROMIS) was also part of this comprehensive evaluation. Two demographically-matched groups of elderly participants were evaluated: one with CLBP (n = 24); and the other without (NCLBP, n = 24). Results revealed significant differences in most of these measures between the two groups, further confirming the importance of using a biopsychosocial approach for future studies of pain and postural control in the elderly. Full article
(This article belongs to the Special Issue Low Back Pain: Recent Advances And Perspectives)
557 KiB  
Article
The Relationship between Pain Beliefs and Physical and Mental Health Outcome Measures in Chronic Low Back Pain: Direct and Indirect Effects
by Andrew Baird and David Sheffield
Healthcare 2016, 4(3), 58; https://doi.org/10.3390/healthcare4030058 - 19 Aug 2016
Cited by 27 | Viewed by 7304
Abstract
Low back pain remains a major health problem with huge societal cost. Biomedical models fail to explain the disability seen in response to reported back pain and therefore patients’ beliefs, cognitions and related behaviours have become a focus for both research and practice. [...] Read more.
Low back pain remains a major health problem with huge societal cost. Biomedical models fail to explain the disability seen in response to reported back pain and therefore patients’ beliefs, cognitions and related behaviours have become a focus for both research and practice. This study used the Pain Beliefs Questionnaire and had two aims: To examine the extent to which pain beliefs are related to disability, anxiety and depression; and to assess whether those relationships are mediated by pain self-efficacy and locus of control. In a sample of 341 chronic low back pain patients, organic and psychological pain beliefs were related to disability, anxiety and depression. However, organic pain beliefs were more strongly related to disability and depression than psychological pain beliefs. Regression analyses revealed that these relationships were in part independent of pain self-efficacy and locus of control. Further, mediation analyses revealed indirect pathways involving self-efficacy and, to a lesser extent chance locus of control, between organic pain beliefs, on the one hand, and disability, anxiety and depression, on the other. In contrast, psychological pain beliefs were only directly related to disability, anxiety and depression. Although longitudinal data are needed to corroborate our findings, this study illustrates the importance of beliefs about the nature of pain and beliefs in one’s ability to cope with pain in determining both physical and mental health outcomes in chronic low back pain patients. Full article
(This article belongs to the Special Issue Low Back Pain: Recent Advances And Perspectives)
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Article
Enhanced Brain Responses to Pain-Related Words in Chronic Back Pain Patients and Their Modulation by Current Pain
by Alexander Ritter, Marcel Franz, Christian Puta, Caroline Dietrich, Wolfgang H. R. Miltner and Thomas Weiss
Healthcare 2016, 4(3), 54; https://doi.org/10.3390/healthcare4030054 - 10 Aug 2016
Cited by 11 | Viewed by 6236
Abstract
Previous functional magnetic resonance imaging (fMRI) studies in healthy controls (HC) and pain-free migraine patients found activations to pain-related words in brain regions known to be activated while subjects experience pain. The aim of the present study was to identify neural activations induced [...] Read more.
Previous functional magnetic resonance imaging (fMRI) studies in healthy controls (HC) and pain-free migraine patients found activations to pain-related words in brain regions known to be activated while subjects experience pain. The aim of the present study was to identify neural activations induced by pain-related words in a sample of chronic back pain (CBP) patients experiencing current chronic pain compared to HC. In particular, we were interested in how current pain influences brain activations induced by pain-related adjectives. Subjects viewed pain-related, negative, positive, and neutral words; subjects were asked to generate mental images related to these words during fMRI scanning. Brain activation was compared between CBP patients and HC in response to the different word categories and examined in relation to current pain in CBP patients. Pain-related words vs. neutral words activated a network of brain regions including cingulate cortex and insula in subjects and patients. There was stronger activation in medial and dorsolateral prefrontal cortex (DLPFC) and anterior midcingulate cortex in CPB patients than in HC. The magnitude of activation for pain-related vs. negative words showed a negative linear relationship to CBP patients’ current pain. Our findings confirm earlier observations showing that pain-related words activate brain networks similar to noxious stimulation. Importantly, CBP patients show even stronger activation of these structures while merely processing pain-related words. Current pain directly influences on this activation. Full article
(This article belongs to the Special Issue Low Back Pain: Recent Advances And Perspectives)
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299 KiB  
Article
Treatment of Lower Back Pain—The Gap between Guideline-Based Treatment and Medical Care Reality
by Andreas Werber and Marcus Schiltenwolf
Healthcare 2016, 4(3), 44; https://doi.org/10.3390/healthcare4030044 - 15 Jul 2016
Cited by 18 | Viewed by 9458
Abstract
Despite the fact that unspecific low back pain is of important impact in general health care, this pain condition is often treated insufficiently. Poor efficiency has led to the necessity of guidelines addressing evidence-based strategies for treatment of lower back pain (LBP). We [...] Read more.
Despite the fact that unspecific low back pain is of important impact in general health care, this pain condition is often treated insufficiently. Poor efficiency has led to the necessity of guidelines addressing evidence-based strategies for treatment of lower back pain (LBP). We present some statements of the German medical care reality. Self-responsible action of the patient should be supported while invasive methods in particular should be avoided due to lacking evidence in outcome efficiency. However, it has to be stated that no effective implementation strategy has been established yet. Especially, studies on the economic impact of different implementation strategies are lacking. A lack of awareness of common available guidelines and an uneven distribution of existing knowledge throughout the population can be stated: persons with higher risk suffering from LBP by higher professional demands and lower educational level are not skilled in advised management of LBP. Both diagnostic imaging and invasive treatment methods increased dramatically leading to increased costs and doctor workload without being associated with improved patient functioning, severity of pain or overall health status due to the absence of a functioning primary care gate keeping system for patient selection. Opioids are prescribed on a grand scale and over a long period. Moreover, opioid prescription is not indicated properly, when predominantly persons with psychological distress like somatoform disorders are treated with opioids. Full article
(This article belongs to the Special Issue Low Back Pain: Recent Advances And Perspectives)
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201 KiB  
Article
Military Chronic Musculoskeletal Pain and Psychiatric Comorbidity: Is Better Pain Management the Answer?
by Cindy A. McGeary, Donald D. McGeary, Jose Moreno and Robert J. Gatchel
Healthcare 2016, 4(3), 38; https://doi.org/10.3390/healthcare4030038 - 30 Jun 2016
Cited by 17 | Viewed by 5672
Abstract
Chronic musculoskeletal pain, such as low back pain, often appears in the presence of psychiatric comorbidities (e.g., depression, posttraumatic stress disorder (PTSD)), especially among U.S. military service members serving in the post-9/11 combat era. Although there has been much speculation about how to [...] Read more.
Chronic musculoskeletal pain, such as low back pain, often appears in the presence of psychiatric comorbidities (e.g., depression, posttraumatic stress disorder (PTSD)), especially among U.S. military service members serving in the post-9/11 combat era. Although there has been much speculation about how to best address pain/trauma psychiatric symptom comorbidities, there are little available data to guide practice. The present study sought to examine how pre-treatment depression and PTSD influence outcomes in a functional restoration pain management program using secondary analysis of data from the Department of Defense-funded Functional and Orthopedic Rehabilitation Treatment (FORT) trial. Twenty-eight FORT completers were analyzed using a general linear model exploring how well depression and PTSD symptoms predict post-treatment pain (Visual Analog Scale (VAS) pain rating), disability (Oswestry Disability Index; Million Visual Analog Scale), and functional capacity (Floor-to-Waist and Waist-to-Eye Level progressive isoinertial lifting evaluation scores) in a sample of active duty military members with chronic musculoskeletal pain and comorbid depression or PTSD symptoms. Analysis revealed that pre-treatment depression and PTSD symptoms did not significantly predict rehabilitation outcomes from program completers. Implications of these findings for future research on trauma-related pain comorbidities are discussed. Full article
(This article belongs to the Special Issue Low Back Pain: Recent Advances And Perspectives)
197 KiB  
Article
Differences in the Association between Depression and Opioid Misuse in Chronic Low Back Pain versus Chronic Pain at Other Locations
by Arpana Jaiswal, Jeffrey F. Scherrer, Joanne Salas, Carissa Van den Berk-Clark, Sheran Fernando and Christopher M. Herndon
Healthcare 2016, 4(2), 34; https://doi.org/10.3390/healthcare4020034 - 16 Jun 2016
Cited by 6 | Viewed by 4359
Abstract
Patients with chronic pain and depression are more likely to develop opioid abuse compared to patients without depression. It is not known if this association differs by pain location. We compared the strength of association between depression and opioid misuse in patients with [...] Read more.
Patients with chronic pain and depression are more likely to develop opioid abuse compared to patients without depression. It is not known if this association differs by pain location. We compared the strength of association between depression and opioid misuse in patients with chronic low back pain (CLBP) vs. chronic pain of other location (CPOL). Chart abstracted data was obtained from 166 patients seeking care in a family medicine clinic. Depression was measured by the PHQ-9 and opioid misuse was measured using the Current Opioid Misuse Measure. Pain severity and interference questions came from the Brief Pain Inventory. Cross-tabulations were computed to measure the association between depression and opioid misuse stratified on pain location. Exploratory logistic regression modeled the association between depression and opioid misuse after adjusting for pain location and pain severity and interference. Depression was significantly associated with opioid misuse in CPOL but not in CLBP. Regression results indicate pain interference partly accounts for the depression–opioid misuse association. These preliminary results from a small patient sample suggest depression may co-occur with opioid misuse more often in CPOL than in CLBP. Further research is needed to compare this comorbidity in specific pain diagnoses such as arthritis, fibromyalgia and CLBP. Full article
(This article belongs to the Special Issue Low Back Pain: Recent Advances And Perspectives)
221 KiB  
Article
Getting “Unstuck”: A Multi-Site Evaluation of the Efficacy of an Interdisciplinary Pain Intervention Program for Chronic Low Back Pain
by Timothy Clark, Jean Claude Wakim and Carl Noe
Healthcare 2016, 4(2), 33; https://doi.org/10.3390/healthcare4020033 - 14 Jun 2016
Cited by 13 | Viewed by 5213
Abstract
Chronic low back pain is one of the major health problems in the U.S., resulting in a large number of years of disability. To address the biopsychosocial nature of pain, interdisciplinary pain programs provide integrated interventions by an interdisciplinary team in a unified [...] Read more.
Chronic low back pain is one of the major health problems in the U.S., resulting in a large number of years of disability. To address the biopsychosocial nature of pain, interdisciplinary pain programs provide integrated interventions by an interdisciplinary team in a unified setting with unified goals. This study examined outcomes of an interdisciplinary program located at two sites with different staff, yet with a unified model of treatment and documentation. Efficacy at the combined sites was examined by comparing standard measures obtained upon admission to the program with measures at completion of a 3–4 week long program for 393 patients with chronic low back pain (CLBP). Repeated measures included pain severity, pain interference, efficacy of self-management strategies, hours of activity, depression, ability to do ADLs, and physical endurance. All repeated measures differed at the p < 0.001 level, with large effect sizes (0.66–0.85). Eighty-two percent of graduates reported being “very much improved” or “much improved”. A second analyses provided evidence that treatment effects were robust across sites with no differences (<0.001) found on five of seven selected outcome measures. A third analysis found that number of days of treatment was correlated on three of seven measures at the <0.01 level. However, the amount of variance explained by days of treatment was under 5% on even the most highly correlated measure. These finding are consistent with previous research and explore short-term effectiveness of treatment across treatment sites and with variable duration of treatment. Full article
(This article belongs to the Special Issue Low Back Pain: Recent Advances And Perspectives)
844 KiB  
Article
Person-Centered, Physical Activity for Patients with Low Back Pain: Piloting Service Delivery
by Saul Bloxham, Phil Barter, Slafka Scragg, Charles Peers, Ben Jane and Joe Layden
Healthcare 2016, 4(2), 28; https://doi.org/10.3390/healthcare4020028 - 18 May 2016
Cited by 5 | Viewed by 5204
Abstract
Low back pain (LBP) is one of the most common and costly conditions in industrialized countries. Exercise therapy has been used to treat LBP, although typically using only one mode of exercise. This paper describes the method and initial findings of a person-centered, [...] Read more.
Low back pain (LBP) is one of the most common and costly conditions in industrialized countries. Exercise therapy has been used to treat LBP, although typically using only one mode of exercise. This paper describes the method and initial findings of a person-centered, group physical activity programme which featured as part of a multidisciplinary approach to treating LBP. Six participants (aged 50.7 ± 17 years) completed a six-week physical activity programme lasting two hours per week. A multicomponent approach to physical activity was adopted which included aerobic fitness, core activation, muscular strength and endurance, Nordic Walking, flexibility and exercise gaming. In addition, participants were required to use diary sheets to record physical activity completed at home. Results revealed significant (p < 0.05) improvements in back strength (23%), aerobic fitness (23%), negative wellbeing (32%) and disability (16%). Person’s Correlation Coefficient analysis revealed significant (p < 0.05) relationships between improvement in perceived pain and aerobic fitness (r = 0.93). It was concluded that a person-centered, multicomponent approach to physical activity may be optimal for supporting patients who self-manage LBP. Full article
(This article belongs to the Special Issue Low Back Pain: Recent Advances And Perspectives)
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220 KiB  
Article
A Controlled and Retrospective Study of 144 Chronic Low Back Pain Patients to Evaluate the Effectiveness of an Intensive Functional Restoration Program in France
by Isabelle Caby, Nicolas Olivier, Frédérick Janik, Jacques Vanvelcenaher and Patrick Pelayo
Healthcare 2016, 4(2), 23; https://doi.org/10.3390/healthcare4020023 - 27 Apr 2016
Cited by 20 | Viewed by 5360
Abstract
Study Design: A controlled and retrospective study of 144 chronic low back pain patients to evaluate the effectiveness of an intensive functional restoration program in France. Objective: Evaluating the efficiency of an intensive, dynamic and multidisciplinary functional restoration program in patients [...] Read more.
Study Design: A controlled and retrospective study of 144 chronic low back pain patients to evaluate the effectiveness of an intensive functional restoration program in France. Objective: Evaluating the efficiency of an intensive, dynamic and multidisciplinary functional restoration program in patients with chronic low back pain (LBP), during 6 and 12 months follow up. Summary of background data: Chronic low back pain disease has a multifactor nature, involving physical, psychological professional and social factors. A functional restoration program (FRP) has been included in a multidisciplinary training program which provides an efficient therapeutic solution. However, the effectiveness of an FRP has not been yet established. Methods: 144 subjects (71 males, 73 females) with chronic low back pain were included in a functional restoration program. The FRP includes physiotherapy and occupational therapy interventions together with psychological counselling. Patients participated as in- or outpatients 6 h per day, 5 days a week over 5 weeks. Pain intensity, trunk flexibility, trunk strength, lifting ability, quality of life and return to work were recorded before, immediately after, and at 6 months and 12 months after the treatment period. Results: All outcome measures were significantly higher just after the FRP (144 patients) and at 6 and 12 months (from available data in 31 subjects) compared to pre-treatment values. This FRP for chronic low back pain maintained its benefits whatever the patient’s activities. Conclusions: The effects reflected on all outcome measures, both on short and long term follow-up. The multidisciplinary FRP for chronic low back pain patients durably stopped the de-conditioning syndrome and involved new life-style habits for the patient, daily pain management and a return to work. Full article
(This article belongs to the Special Issue Low Back Pain: Recent Advances And Perspectives)
1098 KiB  
Article
Relationships between Paraspinal Muscle Activity and Lumbar Inter-Vertebral Range of Motion
by Alister Du Rose and Alan Breen
Healthcare 2016, 4(1), 4; https://doi.org/10.3390/healthcare4010004 - 05 Jan 2016
Cited by 18 | Viewed by 6114
Abstract
Control of the lumbar spine requires contributions from both the active and passive sub-systems. Identifying interactions between these systems may provide insight into the mechanisms of low back pain. However, as a first step it is important to investigate what is normal. The [...] Read more.
Control of the lumbar spine requires contributions from both the active and passive sub-systems. Identifying interactions between these systems may provide insight into the mechanisms of low back pain. However, as a first step it is important to investigate what is normal. The purpose of this study was to explore the relationships between the lumbar inter-vertebral range of motion and paraspinal muscle activity during weight-bearing flexion in healthy controls using quantitative fluoroscopy (QF) and surface electromyography (sEMG). Contemporaneous lumbar sEMG and QF motion sequences were recorded during controlled active flexion of 60° using electrodes placed over Longissimus thoracis pars thoracis (TES), Longissimus thoracis pars lumborum (LES), and Multifidus (LMU). Normalised root mean square (RMS) sEMG amplitude data were averaged over five epochs, and the change in amplitude between epochs was calculated. The sEMG ratios of LMU/LES LMU/TES and LES/TES were also determined. QF was used to measure the maximum inter-vertebral range of motion from L2-S1, and correlation coefficients were calculated between sEMG amplitude variables and these measurements. Intra- and inter-session sEMG amplitude repeatability was also assessed for all three paraspinal muscles. The sEMG amplitude measurements were highly repeatable, and sEMG amplitude changes correlated significantly with L4-5 and L5-S1 IV-RoMmax (r = −0.47 to 0.59). The sEMG amplitude ratio of LES/TES also correlated with L4-L5 IV-RoMmax (r = −0.53). The relationships found may be important when considering rehabilitation for low back pain. Full article
(This article belongs to the Special Issue Low Back Pain: Recent Advances And Perspectives)
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Review

Jump to: Research

1046 KiB  
Review
Revisiting the Corticomotor Plasticity in Low Back Pain: Challenges and Perspectives
by Hugo Massé-Alarie and Cyril Schneider
Healthcare 2016, 4(3), 67; https://doi.org/10.3390/healthcare4030067 - 08 Sep 2016
Cited by 23 | Viewed by 7026
Abstract
Chronic low back pain (CLBP) is a recurrent debilitating condition that costs billions to society. Refractoriness to conventional treatment, lack of improvement, and associated movement disorders could be related to the extensive brain plasticity present in this condition, especially in the sensorimotor cortices. [...] Read more.
Chronic low back pain (CLBP) is a recurrent debilitating condition that costs billions to society. Refractoriness to conventional treatment, lack of improvement, and associated movement disorders could be related to the extensive brain plasticity present in this condition, especially in the sensorimotor cortices. This narrative review on corticomotor plasticity in CLBP will try to delineate how interventions such as training and neuromodulation can improve the condition. The review recommends subgrouping classification in CLBP owing to brain plasticity markers with a view of better understanding and treating this complex condition. Full article
(This article belongs to the Special Issue Low Back Pain: Recent Advances And Perspectives)
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217 KiB  
Review
Core Outcome Sets and Multidimensional Assessment Tools for Harmonizing Outcome Measure in Chronic Pain and Back Pain
by Ulrike Kaiser, Katrin Neustadt, Christian Kopkow, Jochen Schmitt and Rainer Sabatowski
Healthcare 2016, 4(3), 63; https://doi.org/10.3390/healthcare4030063 - 29 Aug 2016
Cited by 16 | Viewed by 5820
Abstract
Core Outcome Sets (COSs) are a set of domains and measurement instruments recommended for application in any clinical trial to ensure comparable outcome assessment (both domains and instruments). COSs are not exclusively recommended for clinical trials, but also for daily record keeping in [...] Read more.
Core Outcome Sets (COSs) are a set of domains and measurement instruments recommended for application in any clinical trial to ensure comparable outcome assessment (both domains and instruments). COSs are not exclusively recommended for clinical trials, but also for daily record keeping in routine care. There are several COS recommendations considering clinical trials as well as multidimensional assessment tools to support daily record keeping in low back pain. In this article, relevant initiatives will be described, and implications for research in COS development in chronic pain and back pain will be discussed. Full article
(This article belongs to the Special Issue Low Back Pain: Recent Advances And Perspectives)
209 KiB  
Review
Who Benefits from Chronic Opioid Therapy? Rethinking the Question of Opioid Misuse Risk
by Elizabeth Huber, Richard C. Robinson, Carl E. Noe and Olivia Van Ness
Healthcare 2016, 4(2), 29; https://doi.org/10.3390/healthcare4020029 - 25 May 2016
Cited by 12 | Viewed by 6290
Abstract
Beginning in the late 1990s, a movement began within the pain management field focused upon the underutilization of opioids, thought to be a potentially safe and effective class of pain medication. Concern for addiction and misuse were present at the start of this [...] Read more.
Beginning in the late 1990s, a movement began within the pain management field focused upon the underutilization of opioids, thought to be a potentially safe and effective class of pain medication. Concern for addiction and misuse were present at the start of this shift within pain medicine, and an emphasis was placed on developing reliable and valid methods and measures of identifying those at risk for opioid misuse. Since that time, the evidence for the safety and effectiveness of chronic opioid therapy (COT) has not been established. Rather, the harmful, dose-dependent deleterious effects have become clearer, including addiction, increased risk of injuries, respiratory depression, opioid induced hyperalgesia, and death. Still, many individuals on low doses of opioids for long periods of time appear to have good pain control and retain social and occupational functioning. Therefore, we propose that the question, “Who is at risk of opioid misuse?” should evolve to, “Who may benefit from COT?” in light of the current evidence. Full article
(This article belongs to the Special Issue Low Back Pain: Recent Advances And Perspectives)
186 KiB  
Review
Surface Electromyographic (SEMG) Biofeedback for Chronic Low Back Pain
by Randy Neblett
Healthcare 2016, 4(2), 27; https://doi.org/10.3390/healthcare4020027 - 17 May 2016
Cited by 44 | Viewed by 7951
Abstract
Biofeedback is a process in which biological information is measured and fed back to a patient and clinician for the purpose of gaining increased awareness and control over physiological domains. Surface electromyography (SEMG), a measure of muscle activity, allows both a patient and [...] Read more.
Biofeedback is a process in which biological information is measured and fed back to a patient and clinician for the purpose of gaining increased awareness and control over physiological domains. Surface electromyography (SEMG), a measure of muscle activity, allows both a patient and clinician to have direct and immediate access to muscle functioning that is not possible with manual palpation or visual observation. SEMG biofeedback can be used to help “down-train” elevated muscle activity or to “up-train” weak, inhibited, or paretic muscles. This article presents a historical and clinical overview of SEMG and its use in chronic low back pain assessment and biofeedback training. Full article
(This article belongs to the Special Issue Low Back Pain: Recent Advances And Perspectives)
247 KiB  
Review
A Systematic Review of the Effects of Exercise and Physical Activity on Non-Specific Chronic Low Back Pain
by Rebecca Gordon and Saul Bloxham
Healthcare 2016, 4(2), 22; https://doi.org/10.3390/healthcare4020022 - 25 Apr 2016
Cited by 213 | Viewed by 41988
Abstract
Back pain is a major health issue in Western countries and 60%–80% of adults are likely to experience low back pain. This paper explores the impact of back pain on society and the role of physical activity for treatment of non-specific low back [...] Read more.
Back pain is a major health issue in Western countries and 60%–80% of adults are likely to experience low back pain. This paper explores the impact of back pain on society and the role of physical activity for treatment of non-specific low back pain. A review of the literature was carried out using the databases SPORTDiscuss, Medline and Google Scholar. A general exercise programme that combines muscular strength, flexibility and aerobic fitness is beneficial for rehabilitation of non-specific chronic low back pain. Increasing core muscular strength can assist in supporting the lumbar spine. Improving the flexibility of the muscle-tendons and ligaments in the back increases the range of motion and assists with the patient’s functional movement. Aerobic exercise increases the blood flow and nutrients to the soft tissues in the back, improving the healing process and reducing stiffness that can result in back pain. Full article
(This article belongs to the Special Issue Low Back Pain: Recent Advances And Perspectives)
178 KiB  
Review
Demoralization, Patient Activation, and the Outcome of Spine Surgery
by Andrew R Block
Healthcare 2016, 4(1), 11; https://doi.org/10.3390/healthcare4010011 - 19 Jan 2016
Cited by 13 | Viewed by 4429
Abstract
It is now well established that psychosocial factors can adversely impact the outcome of spine surgery. This article discusses in detail one such recently-identified “risk” factor: demoralization. Several studies conducted by the author indicate that demoralization, an emotional construct distinct from depression, is [...] Read more.
It is now well established that psychosocial factors can adversely impact the outcome of spine surgery. This article discusses in detail one such recently-identified “risk” factor: demoralization. Several studies conducted by the author indicate that demoralization, an emotional construct distinct from depression, is associated with poorer pain reduction, less functional improvement and decreased satisfaction among spine surgery patients. However, there are indications that the adverse impact of risk factors such as demoralization can be mitigated by psychosocial “maximizing” factors—characteristics that propel the patient towards positive surgical results. One of these maximizing factors, patient activation, is discussed in depth. The patient activation measure (PAM), an inventory assessing the extent to which patients are active and engaged in their health care, is associated not only with improved spine surgery results, but with better outcomes across a broad range of medical conditions. Other maximizing factors are discussed in this article. The author concludes that the past research focus on psychosocial risk factors has limited the value of presurgical psychological screening, and that future research, as well as clinical assessment, should recognize that the importance of evaluating patients’ strengths as well as their vulnerabilities. Full article
(This article belongs to the Special Issue Low Back Pain: Recent Advances And Perspectives)
92 KiB  
Review
The Continuing and Growing Epidemic of Chronic Low Back Pain
by Robert J. Gatchel
Healthcare 2015, 3(3), 838-845; https://doi.org/10.3390/healthcare3030838 - 15 Sep 2015
Cited by 24 | Viewed by 6132
Abstract
Because of the great prevalence of chronic pain, it is not surprising that there have been a number of influential reports by the Institute of Medicine, National Institutes of Health, and the World Health Organization that have documented the medical, social and economic [...] Read more.
Because of the great prevalence of chronic pain, it is not surprising that there have been a number of influential reports by the Institute of Medicine, National Institutes of Health, and the World Health Organization that have documented the medical, social and economic problems caused by it, and the need for better pain-management programs. The present article briefly reviews these reports, and then focuses on three important areas that need to be considered when addressing the continuing and growing epidemic of one of the most prevalent types of chronic pain [chronic low back pain (CLBP)]: the biopsychosocial model of chronic pain; the paradigm shift in medicine from a disease model to an illness model of CLBP; and a review of the treatment- and cost-effectiveness of interdisciplinary chronic pain management programs. This overview will serve as an important prelude to other topics related to low back pain included in this Special Issue of Healthcare. Topics covered will range from assessment and treatment approaches, to important psychosocial mediators/moderators such as coping and pain beliefs. Full article
(This article belongs to the Special Issue Low Back Pain: Recent Advances And Perspectives)
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