Intensive multidisciplinary approach effective for chronic back pain

By Lucy Piper, Senior MedWire Reporter

An intensive interdisciplinary outpatient program for managing chronic back pain has shown clinically significant results in a pilot study.

It "appears to have good short-term clinical results in terms of reduction in functional disability and pain relief," the researchers write in the Journal of Pain Research.

The outpatient program, offered at the University of Ulm in Germany, consists of interventional injection techniques, medication, exercise therapy, back education, ergotherapy, traction, massage therapy, medical training, transcutaneous electrical nerve stimulation, aquatraining, and relaxation.

Within 3 weeks of starting the program in 2010, 160 patients with back pain lasting at least 3 months had shown good improvement in pain and functionality.

Pain intensity, based on the Oswestry Disability Index (ODI), declined by an average 33.3%, with scores decreasing from a baseline value of 34.4% to 24.2%.

Functionality, as measured on the Numeric Rating Scale (NRS), improved by 66.83% with treatment. Average scores fell from a baseline value of 6.0 to 2.0 points after treatment.

"One major benefit of interdisciplinary pain programs lies in the biopsychosocial approach, which focuses on functional restoration and combines a large amount of treatment modalities," Juraj Artner and colleagues comment.

"Also, larger groups of patients can undergo this therapy in contrast to surgical or unimodal conservative treatments, making this therapy cost-effective, especially in patients with significant functional impairment."

The team acknowledges, however, that despite their efficacy, interdisciplinary treatments for back pain still lack standardization regarding the amount and intensity of the therapy regime.

This type of therapy also may not be generalizable to all patient groups; for instance, poor fitness among elderly patients and language problems among immigrants my limit their participation.

The researchers therefore call for further investigation to "define the long-term results, improvement of isolated spinal disorders, interindividual differences in pain ratings, and their dependence on chronification, age, gender, occupation, coping strategies, fear-avoidance, beliefs, and possibly immigration status."

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