Browsing by Subject "Low Back Pain"
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Item The Comorbidity of Emotional Distress with Two Common Acute Pain Populations: Jaw and Low Back(2005-08-11) Edwards, Deidre Marie; Stowell, Anna W.The present study was undertaken to evaluate emotional distress in two common acute pain populations: jaw pain (JAW; n = 135) and low back pain (LB; n=71). Prevalence of psychopathology in each group was evaluated, using the Structured Clinical Interview of Diagnostic and Statistical Manual IV - I and II, and compared to general population estimates. Analyses also examined discrepancies between low risk (LR) JAW and LR LB and high risk (HR) JAW and HR LB. Additionally, medication usage was evaluated to see if differences existed in types of medications used in these groups. Subjects were evaluated on a variety of psychosocial and functional measures, including the Beck Depression Inventory, Multidimensional Pain Inventory, Characteristic Pain Intensity, and Ways of Coping measures. Analyses revealed that there were significant differences between the JAW and LB groups, as well as differences between both risk status groups and the general population and specifically for DSM-IV Diagnoses. JAW subjects were found to have lower BDI and CPI scores, as well as a higher level of functioning on the Global Assessment of Functioning (GAF) from the DSM-IV. JAW patients had significantly more current Axis I and II diagnoses, while the LB group had significantly more lifetime Axis I and II disorders. Both acute pain groups had significantly more Axis I and II disorders than the general population. Additionally, it was discovered that the JAW group used more benzodiazepines, while the LB group used more Schedule II Narcotics. A logistic regression created from significant variables found a six-factor solution, created by the Characteristic Pain Intensity, MPI Coping Style Anomalous, Ways of Coping Problem-Solving, Global Assessment of Functioning, Anxiety Disorders, and Cluster C personality disorder diagnoses, that differentiates the JAW from the LB group. Overall, differences identified between these two groups indicate that the JAW group has increased current psychopathology, while the LB group has more enduring psychopathology. Future treatment should more uniquely correspond to the specific acute pain group.Item A Cost Utility Analysis of Interdisciplinary Early Intervention Versus Treatment as Usual for an At-Risk Population with Acute Low Back Pain(2009-09-04) Rogerson, Mark D.; Gatchel, Robert J.Chronic pain is a costly and debilitating condition that has proven difficult to treat solely with medical interventions due to the complex interplay of biological, psychological, and social factors in its onset and persistence. Many studies have demonstrated the effectiveness of interdisciplinary treatment that includes psychosocial interventions for low back pain. Nevertheless, these interventions continue to be under-utilized due to concerns of cost and applicability. The present study evaluated effectiveness and associated costs by using the objective, standard approach of a cost utility analysis. Individuals with acute low back pain that was considered at high-risk for becoming chronic (according to a previously-demonstrated algorithm) were randomized to either treatment as usual or an interdisciplinary early intervention program. Treatment effectiveness was evaluated using a standard pain measure and quality-adjusted life years (QALYs) from pre-treatment baseline to 12-month follow-up, and associated medical and employment costs were gathered every 3 months for 1 year. Results indicated that subjects improved significantly from pre-treatment to one-year follow-up, and that the early intervention group reported fewer healthcare visits and missed workdays. A cost utility analysis was conducted utilizing 1,000 bootstrapped samples, and the majority of samples indicated the dominance of the early intervention program as being both more effective and less costly from a societal perspective. Within a generally-accepted range of acceptable costs, the early intervention treatment was the preferred option in 85% to 93% of samples. Sensitivity analyses indicated that these effects were robust to changes in estimated values for associated costs. These results indicate encouraging evidence for the cost-effectiveness of interdisciplinary intervention and the benefits of targeted treatment.Item The Development and Preliminary Evaluation of MOTIVATE: Moving to Improve Chronic Back Pain and Depression in Older Adults(2021-03-10) Yang, Ailing Eileen; Makris, Una; Roche, Vivyenne; Saxon, LadonnaBACKGROUND: Chronic low back pain (cLBP) is the 2nd most common reason for physician visits; annual related costs exceed USD 100 billion and are expected to rise with the aging population. cLBP and depression often coexist, and current non-pharmacologic interventions have not focused on older adults with these challenging comorbidities. A feasible, effective non-pharmacologic intervention targeting cLBP and comorbid depressive symptoms in older adults is needed. MOTIVATE (Moving to Improve Chronic Back Pain and Depression in Older Adults) is a novel 8-session, 12-week, telephonic behavioral intervention targeting older adults with cLBP and comorbid depressive symptoms. A health coach utilizes motivational interviewing and value-concordant goal setting to capture individual motivations to increase physical activity. The ultimate goal is to improve back pain-related pain interference, disability, and depressive symptoms. OBJECTIVE: To develop a unique telephone-delivered behavioral intervention that is feasible, increases physical activity, and ultimately improves pain, function, and depressive symptoms among older Veterans. METHODS: In Phase 1, Dr. Makris' research team developed a telephone-delivered multicomponent behavioral intervention that targets older Veterans (>65 years old) with cLBP and comorbid depressive symptoms. Input from stakeholder groups [experts in pain, geriatrics, geriatric psychology, primary care, behavioral interventions, among others (n=8), patients (n=5), and key clinical leaders (n=6)] was used to inform and refine content for this unique population. In Phase 2, we conducted a single-arm rollout of MOTIVATE in older Veterans with cLBP and depressive symptoms to further refine future intervention content, procedures, and delivery based on stakeholder feedback. For qualitative interviews, the Promoting Action on Research Implementation in Health Services (PARIHS) framework was used to develop the discussion guide and facilitate individual interviews with the following key stakeholder groups: Veteran participants (n=4) over the age of 65 with comorbid cLBP and depressive symptoms who received MOTIVATE, primary care providers (PCP) (n=4), clinic director (n=1), and health coach (n=1). RESULTS: Informed by interviews with 14 experts and 5 Veterans, we developed and iteratively refined the MOTIVATE manual and study procedures for Phase 1. In the single-arm MOTIVATE rollout (Phase 2), we enrolled 7 Veterans, with a mean age of 69 years who were predominately white (71%), male (86%), married (57%), and had some education beyond high school (71%). The eligibility mean pain intensity score was 7.3/10; baseline cLBP Pain, Enjoyment of Life, and General (PEG-3) Activity Scale was 7.14/10, back pain-specific Roland Morris Disability Questionnaire (RMDQ) Scale was 16.5/24; and depression PHQ-9 score was 16.7/27, with higher scores indicating greater impairment. Two case studies are provided for additional context and to more fully articulate important MOTIVATE intervention concepts. Upon completion of the intervention, semi-structured interviews with Veterans and other stakeholders provided valuable feedback on how to modify MOTIVATE moving forward. Briefly, Veterans who completed MOTIVATE engaged well with the health coach, were motivated to walk with a pedometer, and felt that being more active reduced pain and depressive symptoms. Of the four PCPs interviewed, all attributed the success of the intervention to the skills and engagement of the health coach; we also learned about the variability in how PCPs would like results relating to patient-identified values and goals to be communicated with them. The health coach noted that Veterans were able to identify value-concordant goals and easily link these to physical activities. All stakeholders stated that the individual health coach plays a critical role in activating and motivating older Veterans with complex medical and psychiatric conditions. CONCLUSION: MOTIVATE content and procedures were developed in Phase 1. The Phase 2 rollout showed that we were able to effectively recruit older Veterans with cLBP and depressive symptoms and deliver MOTIVATE via telephone. Feedback from key stakeholders regarding the iterative refinement of recruitment, study procedures, and content will aid the future evaluation and implementation of MOTIVATE in a pilot randomized controlled trial.Item Early Intervention Options for Acute Low Back Pain Patients: A Prospective One-Year Follow-Up Study(2009-09-04) Whitfill, Travis A.; Gatchel, Robert J.This study represents a continuation of research that has focused on the treatment of acute low back pain (ALBP) patients using techniques designed to address the psychosocial, as well as physical, aspects of pain. Initially, an algorithm was developed by Gatchel et al. (1995a) to identify patients suffering from ALBP who were at high-risk for developing chronic low back pain (CLBP). An interdisciplinary early intervention program was then implemented by Gatchel et al. (2003) to discourage the progression of ALBP to CLBP. Previous studies demonstrated the effectiveness of the early intervention program in reducing levels of pain and disability as compared to those not receiving additional treatment. Another advantage that the treatment group had, relative to the "treatment as usual" group, was cost-effectiveness, as evidenced by lower levels of healthcare utilization, time away from work and medication costs. Due to the important position that work status holds in a discussion of disability and costs associated with injury, a work transition component was added to the early intervention program. Individuals considered high-risk for developing LBP were randomly assigned into one of four groups: early intervention (EI); early intervention with work transition (EI/WT); work transition (NI/W); and non-intervention (NI). A one-year prospective study looked at how these groups differed regarding outcome measures designed to evaluate pain level, coping abilities and work status (Holberg&Gatchel, 2007). Earlier findings were confirmed regarding the effectiveness of early intervention programs at addressing these issues, but a small sample size did not allow for conclusive results. The current study expanded upon previous research by utilizing additional instruments in the measurement of the physical and psychosocial status of those at high risk for developing CLBP, including cortisol analyses intended to demonstrate the interplay between the physical and mental aspects of pain. In addition to these measures, an increase in sample size allowed for greater statistical power and more definitive statements regarding the long-term efficacy of early intervention interdisciplinary programs for the treatment of ALBP.Item Estimate of Muscle Contribution to Spinal Loads During Continuous Passive Motion for Low Back Pain(2005-05-11) Diederich, Jennifer Marie; Triano, John J.This research is a first approximation model for determining the active loads in the lumbar spine during continuous passive motion (CPM) in the prone position. The study consisted of two groups' five healthy subjects and four subjects with the diagnosis of mechanical low back pain (LBP) at L4/L5/S1. Solutions to the issues in this investigation were sought in three stages. First was the introduction and synchronization of a number of sensors for making valid, time-linked observations of kinematic variables during CPM. Second, a root mean square myoelectric signal (RMS-MES) model was needed to calibrate muscle activation levels during feasible standardized tasks to be performed by low back pain patients. Such a model must be able to partition passive and active load components acting on the lumbar spine and to estimate equivalent muscle loads from activity observed during CPM. Finally, biomechanical models are necessary for estimating the passive, active and total loads transmitted through the trunk during CPM. Testing consisted of three calibration stances: upright, weighted holding 3lb weights in hands extended 90?? the shoulder and CPM at intermediate speed 11.5 degrees, fast speed 11.5 degrees, and intermediate speed at 20 degrees. Measurements recorded: 8 myoelectric signals (MES) of paired muscles (latissimus dorsi, multifidus, gluteus maximus, and hamstring femoris), 4 Polhemus Fastrak electromagnetic positioning sensors (lumbar, sacrum, 10cm posterior to center of knee, and table), linear accelerometer, uniaxial load cell, and modified treatment table with AMTI force plate. Results demonstrate consistent repeatable measurements from the instrumented treatment table. The active loads created during CPM are minimal in comparison to the passive loads for both groups and therefore the muscle loads are not counteracting the implied therapy.Item Relationship Between Fear-Avoidance Beliefs Questionaire (FABQ) Scores and Acute Low Back Pain Treatment(2009-09-04) Ingram, Jokae Aisha; Silver, Cheryl H.Each year, millions of individuals are afflicted with low back pain. Clinical researchers have a growing concern that patients' acute pain will develop into chronic pain, partly because of their fear-avoidance beliefs often resulting in them not returning to work (George, 2006; Pincus, 2002). The aims of this present study were as follows: a) to examine if FABQ risk criteria was significantly related to risk criteria with the ALBP algorithm; b) to examine the differences in patients' fear-avoidance beliefs scores and their return-to-work status; c) to examine the relationship between FABQ scores and scores on other psychosocial pain measures; d) to examine the FABQ scores for those who completed treatment, compared to those who did not complete treatment; and e) to examine the differences in FABQ scores from pre-treatment to one-year follow-up. The risk criteria with the ALBP algorithm was significantly related to risk criteria on the FABQ-W, but not significantly related to risk criteria on the FABQ-PA. Patients who returned to work tended to have lower FABQ scores than patients who did not return to work. Findings indicated that patients who had higher fear-avoidance beliefs (high FABQ scores) were more likely to have obstacles that prevented them from returning to work. Also, patients with higher fear avoidance beliefs tended to perceive their overall health status as poor. Patients who were classified as 'adaptive copers' tended to have lower FABQ scores than patients classified as 'dysfunctional' which indicates patients classified as 'adaptive copers' utilize healthier coping skills. No significant difference was found between those who completed treatment and those who did not complete treatment. Additionally, patients tended to have higher fear-avoidance beliefs at pre-treatment than at one-year follow-up indicating some potential benefits of treatment. Overall, patients who tended to have high fear-avoidance beliefs were more likely not to return to work, have more obstacles when trying to return to work, perceived their overall health status as poor, and were less likely to utilize healthy coping, hence their avoidance behavior.Item Treatment of Early Intervention for Acute Low Back Pain Patients Utilizing a "Back-To-Work Transition" Component: A One-Year Prospective Study(2007-08-08) Holberg, Christine M.; Stowell, Anna W.This study built upon previous research by Gatchel et al. (2003) which utilized an algorithm developed by Gatchel et al. (1995), to identify what patients with ALBP were at high-risk for developing chronic pain and then implemented an interdisciplinary early intervention program in order to prevent the progression of ALBP to chronic low back pain (CLBP). The aforementioned authors were able to demonstrate the effectiveness of the early-intervention program as measured by decreases on a number of pain and disability-related measures as compared to "treatment as usual." In addition, they established the cost-effectiveness of such a program as compared to "treatment as usual" in terms of costs of medications, disability days, and healthcare utilization. The current study expanded upon the early-intervention program established by Gatchel et al. (2003) by adding a work transition component to better facilitate improved return-to-work and better work-related outcomes. In addition, the study set out to establish the effectiveness of the early-intervention and work transition component as well. After subjects were identified as being at high-risk for developing chronic pain, they were randomized into one of four treatment groups: early intervention (EI); early intervention with work transition (EI/W); work transition (NI/W); and non-intervention (NI), and followed-up for a period of 1-year. A limitation of the study was small sample size and resulting reductions A limitation of the study was small sample size and resulting reductions in statistical power. Despite this, the findings confirm prior studies that show early intervention with an acute pain population is important for achieving pain reduction, improved coping abilities, and return to work rates. Significant reductions in pain ratings were noted for the EI group from intake to 1-year. Overall, pain ratings for the EI, EI/W, and NI/W groups were observed to be comparable to one another and all were noted to be lower than NI group pain ratings at 1-year. In addition the EI, EI/W, and NI/W groups all demonstrated significant increases on a measure of coping that assesses an overall sense of control over physical well-being. Significant decreases and moderate decreases in functional disability were found for the EI group and EI/W group respectively from intake to 1-year. Results on a measure of obstacles to return-to-work indicated a moderately improved prognosis for return-to-work for the EI group at 1-year.Item [UT News](1985-10-21) Waggoner, Lori