Journal ArticleDOI
Behavioral Treatment for Chronic Low Back Pain : A Systematic Review Within the Framework of the Cochrane Back Review Group
Maurits W. van Tulder,Raymond W. J. G. Ostelo,T. Johan W. S. Vlaeyen,Steven J. Linton,Stephen Morley,Willem J. J. Assendelft +5 more
TLDR
Behavioral treatment seems to be an effective treatment for patients with chronic low back pain,but it is still unknown what type of patients benefit most from whattype of behavioral treatment.Abstract:
Study Design. A systematic review of randomized controlled trials. Summary of Background Data. The treatment of chronic low back pain is not primarily focused on removing an underlying organic disease but at the reduction of disability through the modification of environmental contingencies and cognitive processes. Behavioral interventions are commonly used in the treatment of chronic (disabling) low back pain. Objectives. To determine whether behavioral therapy is more effective than reference treatments for chronic nonspecific low back pain and which type of behavioral treatment is most effective. Methods. The authors searched the Medline and PsychLit databases and the Cochrane Controlled Trials Register up to April 1999. and Embase up to September 1999. Also screened were references of identified randomized trials and relevant systematic reviews. Methodologic quality assessment and data extraction were performed independently by two reviewers. The magnitude of effect was assessed by computing a pooled effect size for each domain (i.e., behavioral outcomes, overall improvement, back pain-specific and generic functional status, return to work, and pain intensity) using the random effects model. Results. Only six (25%) studies were high quality. There is strong evidence (level 1) that behavioral treatment has a moderate positive effect on pain intensity (pooled effect size 0.62; 95% confidence interval [CI] 0.25, 0.98), and small positive effects on generic functional status (pooled effect size 0.35; 95% CI: 0.04, 0.74) and behavioral outcomes (pooled effect size 0.40; 95% CI: 0.10, 0.70) of patients with chronic low back pain when compared-with waiting-list controls or no treatment. There is moderate evidence (level 2) that a addition of behavioral component to a usual treatment program for chronic low backpain has no positive short-term effect on generic functional status (pooled effect size 0.31; 95% Cl: 0.01, 0.64), pain intensity (pooled effect size 0.03; 95% CI: 0.30, 0.36), and behavioral outcomes (pooled effect size 0.19; 95% CI: 0.08, 0.45). Conclusions. Behavioral treatment seems to be an effective treatment for patients with chronic low back pain,but it is still unknown what type of patients benefitmost from what type of behavioral treatment.read more
Citations
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Journal ArticleDOI
Chapter 4. European guidelines for the management of chronic nonspecific low back pain.
Journal ArticleDOI
Clinical Guidelines for the Use of Chronic Opioid Therapy in Chronic Noncancer Pain
Roger Chou,Gilbert J. Fanciullo,Perry G. Fine,Jeremy A Adler,Jane C. Ballantyne,Pamela Stitzlein Davies,Marilee I. Donovan,David A. Fishbain,Kathy M. Foley,Jeffrey Fudin,Aaron M. Gilson,Alexander Kelter,Alexander Mauskop,Patrick G. O'Connor,Steven D. Passik,Gavril W. Pasternak,Russell K. Portenoy,Ben A. Rich,Richard G. Roberts,Knox H. Todd,Christine Miaskowski +20 more
TL;DR: Safe and effective chronic opioid therapy for chronic noncancer pain requires clinical skills and knowledge in both the principles of opioid prescribing and on the assessment and management of risks associated with opioid abuse, addiction, and diversion.
Journal ArticleDOI
The fear-avoidance model of musculoskeletal pain: current state of scientific evidence.
M. Leeuw,Mariëlle E.J.B. Goossens,Steven J. Linton,Geert Crombez,Katja Boersma,Johan W.S. Vlaeyen +5 more
TL;DR: The current state of scientific evidence for the individual components of the fear-avoidance model: pain severity, pain catastrophizing, attention to pain, escape/avoidance behavior, disability, disuse, and vulnerabilities is reviewed.
Journal ArticleDOI
Non-specific low back pain
TL;DR: Two treatment strategies are currently used, a stepped approach beginning with more simple care that is progressed if the patient does not respond, and the use of simple risk prediction methods to individualise the amount and type of care provided.
Journal ArticleDOI
Nonpharmacologic Therapies for Acute and Chronic Low Back Pain: A Review of the Evidence for an American Pain Society/American College of Physicians Clinical Practice Guideline
Roger Chou,Laurie Hoyt Huffman +1 more
TL;DR: Current evidence on noninvasive therapies for low back pain in adults is summarized and several therapies that have not been studied in the United States or are not widely available are reviewed in the complete evidence review.
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