Articles: back-pain.
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Back pain is prevalent in the population, sometimes recurrent and may result in everyday and work disabilities. It is often a reason for seeking healthcare support. Analyzing the need of treatment and chronification-risk tailored intervention is a particular demand in healthcare delivery. ⋯ Tailored, interdisciplinary and intensive intervention is effective in reducing downstream consequences of back pain. The treatment assignment was based on patient reports (GPQ score) and multidisciplinary assessments (clinical evidence score). Tailored interventions should include sufficient intensity for highly disabled patients. Care integration such as timely communication between the health insurance system, back pain centers and usual healthcare services as well as patient- and process-related documentation are crucial for this intervention.
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Randomized Controlled Trial
Telehealth Therapy Effects of Nurses and Mental Health Professionals From 2 Randomized Controlled Trials for Chronic Back Pain.
To compare the efficacy of mental health professional versus primary care nurse-delivered telehealth cognitive-behavioral therapy (CBT) and supportive care (SC) treatments for chronic low back pain, using data from 2 separate randomized controlled trials. Both trials were completed in the same hospital and used the same study design, research team, and outcome measures. ⋯ Results from these clinical trials suggest that the benefits of home-based, telehealth-delivered CBT and SC treatments for chronic back pain were comparable when delivered by a primary care nurse or mental health professional.
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Review Meta Analysis
Pain and disability after first-time spinal fusion for lumbar degenerative disorders: a systematic review and meta-analysis.
Lumbar spinal fusion (LSF) is frequently and increasingly used in lumbar degenerative disorders despite conflicting results and recommendations. A thorough understanding of patient outcomes after LSF is required to inform decisions regarding surgery and to improve post-surgery management. The current study aims to evaluate the course of pain and disability in patients with degenerative disorders of the lumbar spine after first-time LSF. ⋯ There is a substantial improvement in pain and disability after first-time LSF for degenerative disorders. However, long-term outcomes indicate that leg pain might be more reduced and for a longer period of time than axial back pain and disability. Registration PROSPERO CRD42015026922. These slides can be retrieved under Electronic Supplementary Material.
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It is generally assumed that individuals exhibiting high pain inhibition also tend to exhibit low pain facilitation, but little research has examined this association in individuals with pain. The aims of this cross-sectional study were 1) to examine the association between measures of conditioned pain modulation (CPM) and temporal summation (TS) in individuals with chronic pain, and 2) to examine whether this association was moderated by demographic (age, sex), psychological (depression, catastrophizing), or medication-related (opioid use) variables. Individuals (N= 190) with back or neck pain completed questionnaires and underwent a series of quantitative sensory testing procedures assessing CPM and TS. ⋯ The magnitude of CPM was lower for opioid users than nonusers, suggesting that opioid use might dampen the functioning of endogenous pain-inhibitory systems and possibly contribute to a discordance between measures of pain inhibition and pain facilitation. PERSPECTIVE: Results of the present study indicated that greater endogenous pain-inhibitory capacity is associated with lower levels of pain facilitation. This association, however, was not significant among opioid users, suggesting that opioids might compromise the functioning and interrelationship between endogenous pain modulatory systems.