[Multidisciplinary treatment program on chronic low back pain, part 3. Psychosocial aspects]

[Treatment for chronic back pain? : Active multimodal, interdisciplinary pain therapy vs. physiotherapy-physical therapy for chronic back pain]

BACKGROUND

In industrialized countries, chronic back pain is referred to as the "number one common disease".

OBJECTIVES

Are there any indications of different outcomes of chronic back pain patients when treated with a multimodal, interdisciplinary pain therapy (MMSTh) compared to physiotherapy-physical therapy?

MATERIALS AND METHODS

Entrance and final examination by means of survey, questionnaires and physical tests in the intervention and control group, evaluation and comparison of the results.

RESULTS

The intervention group showed very significant improvements in all tests. In contrast, the control group achieved only partial improvements in physical parameters and quality of life. This resulted in clear group differences in favor of the MMSTh. In terms of patient satisfaction, the control group showed a better result than the intervention group.

CONCLUSIONS

Treatment with MMSTh is superior to standard physiotherapy-physical. Due to the extensive, proven positive effect on many pain-causing and pain-preserving factors, multimodal pain centers should be used more frequently in chronic back pain patients.

[Long-term effects of interventional treatment on chronic pain of the musculoskeletal system. Retrospective outcome study of repeated in-patient treatment]

INTRODUCTION

Interventional procedures are frequently used for treatment of musculoskeletal pain syndromes but current scientific evidence does not show successful outcome in chronic cases. In this study the effect of repeated interventional treatment on the long-term outcome of patients with chronic musculoskeletal pain was examined.

MATERIALS AND METHODS

In order to prepare for a retrospective outcome study (RCT) on proliferation therapy the clinical records of 38 patients who had been repeatedly treated (minimum 5 times) with an interventional treatment concept were examined.

RESULTS

Patients were treated on average 10 times with approximately 107 single injections during each treatment cycle. In the long term the chronic pain syndrome showed a statistically significant deterioration with a generalization of the pain as well as an increase in pain medication, surgery and psychosocial impairment..

DISCUSSION

Repeated treatment cycles of interventional pain therapy did not lead to an improvement in the treated pain syndromes and in the long term the pain syndromes deteriorated further. It seems likely that the interventional approach promoted this adverse development but the data of this study are not sufficient to conclusively prove this thesis.

[Pain and pain-related behavior during orthopedic rehabilitation]

BACKGROUND

Problems concerning the sustainability of medical rehabilitation are well known. Persistent avoidance behavior might be a potential cause. The present study is designed to determine the relationship between pain and pain-related behavior (resignation, distraction, avoidance) during the rehabilitation process. In addition, the impact of gender, age, level of chronicity, and location of ailments are investigated.

METHODS

Pain (German pain perception scale, SES) and pain-related behavior (German pain control questionnaire, FSR) were measured in 309 orthopedic rehabilitation patients.

RESULTS

Affective pain, resignation and distraction are more pronounced in women than in men. Participants with highly increased levels of chronicity have more affective and sensory pain and higher values of avoidance and resignation. During the rehabilitation process, there was a decrease in affective pain, sensory pain and resignation. The difference values correlate significantly.

CONCLUSION

Rehabilitation is effective for pain reduction. However, only limited changes in pain-related behavior were detected.

[Multimodal integrated assessment and treatment of patients with back pain. Pain related results and ability to work]

INTRODUCTION

The results of conventional chronic back pain therapy are unsatisfactory. Deconditioning, psychosocial disorders and prolonged disability are common sequelae.

MATERIAL AND METHODS

The health insurance fund Deutsche Angestellten Krankenkasse (DAK) offers an interdisciplinary assessment by the Berlin-Brandenburg back pain network (BBR) to its members with ongoing work disability on account of back pain. After medical, physiotherapeutic and psychological exploration one of the following four options is suggested: further diagnostics, outpatient monomodal treatment, day-care pain management program of two intensities or inpatient pain treatment. The data of 394 patients with the leading diagnostic group of back pain (M54, ICD 10, 65.7%) and disability for 92.7 days (mean) are presented.

RESULTS

The patients were severely impaired in physical and psychosocial aspects. The chronification was moderate (stage II-III of Mainz Staging System, MPSS). The success of treatment was evaluated 6 months after the initial assessment. All groups showed a significant reduction of pain, anxiety and depression whereas the wellbeing and daily activities improved, but best in the day-care pain management groups.

CONCLUSION

Patient selection by a health fund, interdisciplinary assessment and severity adapted treatment resulted in significant reduction in pain and functional improvement in disabled back pain patients.

[Analysis of the cost of illness in backache]

BACKGROUND

Back pain has become quite a health problem in today's modern industrial society. Even though an excellent network of doctors and efficient treatments is available and most of the patients need only a few treatments, back pain is a common cause of illness and inability to work. This amounts to a considerable reduction in quality of life for those affected, additionally this also leads to a high economic burden for the national economy and the solidarity of the insured.

COST ANALYSIS

The total costs caused by back pain come up to about 34 billion DM per year according to the present study. Ten billion DM of these amount to direct costs, which are divided into costs for physician visits (including diagnostic procedures) at about 35%, hospital, treatment at about 22%, rehabilitation at about 21%, physical therapy at about 17% and medication at about 5%. Regarding total costs, which are composed of around 70% indirect costs, the direct costs relativize immensly.

CONCLUSION

Savings through restrictive prescriptions for medications therefore have no great impact on total costs. Only a more efficient therapy, which reduces sick days, number of recurrences and development of chronic illness as well as a more effective prevention, is able to limit the costs of back pain in the long-run. Therefore, more research on a broader base may result in a significant benefit in this area.