Advertisement

Prescribing Conservative Treatment for Low Back Pain

  • F. Balagué
  • J. Dudler
Chapter

Abstract

As clinicians, prescribing conservative treatment is an essential part of our daily activity. Prescriptions are based on knowledge, and evidences are available for the different therapies in LBP. However, evidence is just a measure of the generalizability, or external validity, of the efficacy of a given treatment. In other terms, how well some form of treatment performs for an “average patient” or a group of patients, a measure usually defined within the frame of a scientific study. In an era of limited healthcare resources, all our patients would be ideally “average,” and treatments would be evidence-based. Only treatments demonstrated to be effective would be considered and used for LBP, as for any other condition.

Keywords

Neck Pain Patient Limited Healthcare Resource Usual Physiotherapy Late Dropout Understandable Explanation 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

References

  1. 1.
    Airaksinen O, Brox JI, Cedraschi C, Hildebrandt J, Klaber-Moffett J, Kovacs F, Mannion AF, Reis S, Staal J, Ursin H, Zanoli G; COST B13 Working Group on Guidelines for Chronic Low Back Pain (2006) Chapter 4. European guidelines for the management of chronic nonspecific low back pain. Eur Spine J 15:S192–S300Google Scholar
  2. 2.
    Balagué F, Cedraschi C (2006) Radiological examination in low back pain patients: anxiety of the patient? Anxiety of the therapist? Joint Bone Spine 73:508–513CrossRefPubMedGoogle Scholar
  3. 3.
    Balagué F, Mannion AF, Pellisé F, Cedraschi C (2007) Clinical update: low back pain. The Lancet 369:726–728CrossRefGoogle Scholar
  4. 4.
    Bindman AB, Forrest CB, Britt H, Crampton P, Majeed A (2007) Diagnostic scope of and exposure to primary care physicians in Australia, New Zealand, and the United States: cross sectional analysis of results from three national surveys. BMJ 334:1261CrossRefPubMedGoogle Scholar
  5. 5.
    Burton AK, Balague F, Cardon G, Eriksen HR, Henrotin Y, Lahad A, Leclerc A, Muller G, van der Beek AJ; Pain CBWGoGfPiLB (2006) Chapter 2. European guidelines for prevention in low back pain. Eur Spine J 15:S136–S168CrossRefGoogle Scholar
  6. 6.
    Carragee E (2007) Validity of self-reported history in patients with acute back or neck pain after motor vehicle accidents. Spine J 8(2):311–319CrossRefPubMedGoogle Scholar
  7. 7.
    Chou R, Qaseem A, Snow V, Casey D, Cross T, Shekelle P, Owens DK (2007) Diagnosis and treatment of low back pain: a joint clinical practice guideline from the American college of physicians and the American pain society. Ann Intern Med 147:478–491PubMedGoogle Scholar
  8. 8.
    Chou R, Hoyt Huffman L (2007) 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. Ann Intern Med 147:492–504PubMedGoogle Scholar
  9. 9.
    Chou R, Hoyt Huffman L (2007) Medications for acute and chronic low back pain: a review of the evidence for an American pain society/American college of physicians clinical practice guideline. Ann Intern Med 147:505–514PubMedGoogle Scholar
  10. 10.
    Cohen RI, Chopra P, Upshur C (2001) Low back pain, part 2. Guide to conservative, medical, and procedural therapies. Geriatrics 56:38–47PubMedGoogle Scholar
  11. 11.
    Deshpande A, Furlan A, Mailis-Gagnon A, Atlas S, Turk D (2007) Opioids for chronic low-back pain. Cochrane Database Syst Rev (3):CD004959Google Scholar
  12. 12.
    Eisenberg DM, Kessler RC, Van Rompay MI, Kaptchuk TJ, Wilkey SA, Appel S, Davis RB (2001) Perceptions about complementary therapies relative to conventional therapies among adults who use both: results from a national survey. Ann Intern Med 135:344–351PubMedGoogle Scholar
  13. 13.
    Friedlieb OP (1994) The impact of managed care on the diagnosis and treatment of low back pain: a preliminary report. Am J Med Qual 9:24–29CrossRefPubMedGoogle Scholar
  14. 14.
    Fullen BM, Maher T, Bury G, Tynan A, Daly LE, Hurley DA (2007) Adherence of Irish general practitioners to European guidelines for acute low back pain: a prospective pilot study. Eur J Pain 11:614–623CrossRefPubMedGoogle Scholar
  15. 15.
    Furlan A, Clarke J, Esmail R, Sinclair S, Irvin E, Bombardier C (2001) A critical review of reviews on the treatment of chronic low back pain. Spine 26:E155–E162CrossRefPubMedGoogle Scholar
  16. 16.
    Jackson JL, Browning R (2005) Impact of national low back pain guidelines on clinical practice. South Med J 98: 139–143CrossRefPubMedGoogle Scholar
  17. 17.
    Jamison RN, Gintner L, Rogers JF, Fairchild DG (2002) Disease management for chronic pain: barriers of program implementation with primary care physicians. Pain Med 3: 92–101CrossRefPubMedGoogle Scholar
  18. 18.
    Janicki P, Schuler G, Francis D, Bohr A, Gordin V, Jarzembowski T, Ruiz-Velasco V, Mets B (2006) A genetic association study of the functional A118G polymorphism of the human mu-opioid receptor gene in patients with acute and chronic pain. Anesth Analg 103:1011–1017CrossRefPubMedGoogle Scholar
  19. 19.
    Joines JD (2006) Chronic low back pain: progress in therapy. Curr Pain Headache Rep 10:421–425CrossRefPubMedGoogle Scholar
  20. 20.
    Kent P, Keating J (2004) Do primary-care clinicians think that nonspecific low back pain is one condition? Spine 29:1022–1031CrossRefPubMedGoogle Scholar
  21. 21.
    Kirchheiner J, Brockmöller J (2005) Clinical consequences of cytochrome P450 2C9 polymorphisms. Clin Pharmacol Ther 77:1–16CrossRefPubMedGoogle Scholar
  22. 22.
    Krismer M, van Tulder M (2007) Low back pain (non-specific). Best Pract Res Clin Rheumatol 21:77–91CrossRefPubMedGoogle Scholar
  23. 23.
    Laerum E, Indahl A, Skouen JS (2006) What is “the good back-consultation”? A combined qualitative and quantitative study of chronic low back pain patients’ interaction with and perceptions of consultations with specialists. J Rehabil Med 38:255–262CrossRefPubMedGoogle Scholar
  24. 24.
    Lewis CL, Wickstrom GC, Kolar MM, Keyserling TC, Bognar BA, DuPre CT, Hayden J (2000) Patients preferences for care by general internists and specialists in the ambulatory setting. J Gen Intern Med 15:75–83CrossRefPubMedGoogle Scholar
  25. 25.
    Main CJ, Sullivan MJL, Watson PJ Edinburgh (2008) Pain management. Practical applications of the biopsychosocial perspective in clinical and occupational settings, 2nd edn. Churchill Livingstone Elsevier, EdinburghGoogle Scholar
  26. 26.
    Manca A, Epstein DM, Torgerson DJ, Klaber Moffett JA, Coulton S, Farrin AJ, Hahn S, Jackson DA, Richmond SJ (2006) Randomized trial of a brief physiotherapy intervention compared with usual physiotherapy for neck pain patients: cost-effectiveness analysis. Intl J Technol Assess Health Care 22:67–75Google Scholar
  27. 27.
    Manca A, Dumville JC, Torgerson DJ, Klaber Moffett JA, Mooney MP, Jackson DA, Eaton S (2007) Randomized trial of two physiotherapy interventions for primary care back and neck pain patients: cost-effectiveness analysis. Rheumatology 46:1495–1501CrossRefPubMedGoogle Scholar
  28. 28.
    McCarthy C, Gittins M, Roberts C, Oldham J (2007) The reliability of the clinical tests and questions recommended in international guidelines for low back pain. Spine 32: 921–926CrossRefPubMedGoogle Scholar
  29. 29.
    Nordin M, Cedraschi C, Skovorn ML (1998) Patient-health care provider relationship in patients with non-specific low back pain: a review of some problem situations. Baillière’s Clin Rheumatol 12:75–92CrossRefGoogle Scholar
  30. 30.
    Oleske DM, Morrissey Kwasny M, Lavender SA, Andersson GBJ (2007) Participation in occupational health longitudinal studies: predictors of missed visits and dropouts. Ann Epidemiol 17:9–18CrossRefPubMedGoogle Scholar
  31. 31.
    Perreault K, Dionne CE (2006) Does patient-physiotherapist agreement influence the outcome of low back pain? A prospective cohort study. BMC Musculoskeletal Disord Sep 20;7:76Google Scholar
  32. 32.
    Pfeffer J, Sutton RI (2006) Evidence-based management. Harv Bus Rev 84:62–74, 133PubMedGoogle Scholar
  33. 33.
    Pulliam C, Gatchel RJ, Robinson RC (2003) Challenges to early prevention and intervention: personal experiences with adherence. Clin J Pain 19:114–120CrossRefPubMedGoogle Scholar
  34. 34.
    Rosemann T, Joos S, Koerner T, Heiderhoff M, Laux G, Szecsenyi J (2006) Use of a patient information leaflet to influence patient decisions regarding mode of administration of NSAID medications in case of acute low back pain. Eur Spine J 15:1737–1741CrossRefPubMedGoogle Scholar
  35. 35.
    Sackett DL, Rosenberg WM, Gray JA, Haynes RB, Richardson WS (1996) EBM: what it is and what it isn’t. BMJ 312:71–72PubMedGoogle Scholar
  36. 36.
    Schers H, Braspenning J, Drijver R, Wensing M, Grol R (2000) Low back pain in general practice: reported management and reasons for not adhering to guidelines in The Netherlands. Br J Gen Pract 50:640–644PubMedGoogle Scholar
  37. 37.
    Schers H, Wensing M, Huijsmans Z, van Tulder M, Grol R (2001) Implementation barriers for general practice guidelines on low back pain. Spine 26:E348–E353CrossRefPubMedGoogle Scholar
  38. 38.
    Schneider S, Mohnen S, Schiltenwolf M, Rau C (2007) Comorbidity of low back pain: representative outcomes of a national health study in the Federal Republic of Germany. Eur J Pain 11:387–397CrossRefPubMedGoogle Scholar
  39. 39.
    Stamer U, Stüber F (2007) The pharmacogenetics of analgesia. Expert Opin Pharmacother 8:2235–2245CrossRefPubMedGoogle Scholar
  40. 40.
    Turk DC, Dworkin RH (2004) What should be the core outcomes in chronic pain clinical trials? Arthritis Res Ther 6:151–154CrossRefPubMedGoogle Scholar
  41. 41.
    van Tulder M, Becker A, Bekkering T, Breen A, del Real MT, Hutchinson A, Koes B, Laerum E, Malmivaara A; Care CBWGoGftMoALBPiP (2006) Chapter 3. European guidelines for the management of acute nonspecific low back pain in primary care. Eur Spine J 15:S169–S191CrossRefGoogle Scholar
  42. 42.
    Zelman D, Smith M, Hoffman D, Edwards L, Reed P, Levine E, Siefeldin R, Dukes E (2004) Acceptable, manageable, and tolerable days: patient daily goals for medication management of persistent pain. J Pain Symptom Manage 28: 474–487CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2010

Authors and Affiliations

  1. 1.Service de Rhumatologie, Médicine Physique et RéhabilitationHFR-Hospital CantonalFribourgSwitzerland

Personalised recommendations