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Do analgesics improve functioning in patients with chronic low back pain? An explorative triple-blinded RCT

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Abstract

Purpose

Treatment of patients with chronic low back pain (CLBP) aims to reduce disability, improve functional capacity, and participation. Time contingent prescription of analgesics is a treatment modality in CLBP. The impact of analgesics on functional capacity is unknown. Aim of the study was to explore the effect of analgesics on functioning measured by functional capacity evaluation, and self-reported disability in patients with CLBP.

Methods

Explorative Randomized Placebo-Controlled Clinical Trial was performed in an outpatient pain rehabilitation setting on patients waiting for rehabilitation. Included patients had low back pain lasting >3 months, visual analogue scale worst pain ≥4.0 cm, and age >18 years. Outcome measures before (T0) and after treatment (T1): functional capacity, pain intensity, Roland Morris Disability Questionnaire. T1: global perceived pain relief. Patient characteristics and psychological questionnaires were assessed. Fifty patients were included in this study and were randomly assigned to 2 weeks treatment or placebo. Treatment: acetaminophen/tramadol 325 mg/37.5 mg per capsule. Dose: maximum acetaminophen 1,950 mg and tramadol 225 mg per day; treatment and placebo titrated identically. Compliance and side-effects were monitored. Treatment effects between groups over time were compared.

Results

One patient (treatment group) was lost to follow-up. Forty-nine patients remained in the study. Treatment effects in primary outcomes did not differ significantly between groups. A subgroup of 10 (42 %) patients (treatment group) reported global pain relief (responders) who reduced self-reported disability (p < 0.05). Responders had significantly lower catastrophizing scores.

Conclusion

Overall treatment effects were small and non-significant. A subgroup, however, reported improved functioning as a result of treatment. Responders had lower catastrophizing scores.

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References

  1. Truchon M (2001) Determinants of chronic disability related to low back pain: towards an integrative biopsychosocial model. Disabil Rehab 23:758–767

    Article  CAS  Google Scholar 

  2. Borenstein DG (2001) Epidemiology, etiology, diagnostic evaluation, and treatment of low back pain. Curr Opin Rheumatol 13:128–134

    Article  CAS  PubMed  Google Scholar 

  3. WHO (2001) International classification of functioning, disability and health (ICF). World Health Organization, Geneva

    Google Scholar 

  4. Linton SJ (2000) A review of psychological risk factors in back and neck pain. Spine 25:1148–1156

    Article  CAS  PubMed  Google Scholar 

  5. Schiphorst Preuper HR, Reneman MF, Boonstra AM, Dijkstra PU, Versteegen GJ, Geertzen JHB, Brouwer S (2009) Relationship between psychological factors and performance-based and self-reported disability in chronic low back pain. Eur Spine J 17:1448–1456

    Article  Google Scholar 

  6. NHG-Standaard aspecifieke lagerugpijn (Dutch standard low-back pain) (2005):M54. (Dutch). Huisarts en Wetenschap

  7. Reig E (2002) Tramadol in musculoskeletal pain-a survey. Clin Rheumatol 21:S9–11 discussion S11-2

    Article  PubMed  Google Scholar 

  8. Ruoff GE, Rosenthal N, Jordan D, Karim R, Kamin M (2003) Tramadol/acetaminophen combination tablets for the treatment of chronic lower back pain: a multicenter, randomized, double-blind, placebo-controlled outpatient study. Clin Ther 25:1123–1141

    Article  CAS  PubMed  Google Scholar 

  9. Gross DP (2006) Are functional capacity evaluations affected by the patient’s pain? Curr Pain Headache Rep 10:107–113

    Article  PubMed  Google Scholar 

  10. Gross DP, Bhambhani Y, Haykowsky MJ, Rashiq S (2008) Acute opioid administration improves work-related exercise performance in patients with chronic back pain. J Pain 9:856–862

    Article  CAS  PubMed  Google Scholar 

  11. Brouwer S, Reneman MF, Dijkstra PU, Groothoff JW, Schellekens JM, Goeken LN (2003) Test-retest reliability of the Isernhagen Work Systems Functional Capacity Evaluation in patients with chronic low back pain. J Occup Rehabil 13:207–218

    Article  CAS  PubMed  Google Scholar 

  12. Gross DP, Battié MC (2003) Construct validity of a kinesiophysical functional capacity evaluation administered within a worker’s compensation environment. J Occup Rehabil 13:287–295

    Article  PubMed  Google Scholar 

  13. Roland M, Morris R (1983) A study of the natural history of low back pain: Part 1: development of a reliable and sensitive measure of disability in low-back pain. Spine 8:141–144

    Article  CAS  PubMed  Google Scholar 

  14. Brouwer S, Kuijer W, Dijkstra PU, Göeken LN, Groothoff JW, Geertzen JH (2004) Reliability and stability of the Roland Morris Disability Questionnaire: intra class correlation and limits of agreement. Disabil Rehabil 26:162–165

    Article  CAS  PubMed  Google Scholar 

  15. Farrar JT, Portenoy RK, Berlin JA, Kinman JL, Strom BL (2000) Defining the clinically important difference in pain outcome measures. Pain 88:287–294

    Article  CAS  PubMed  Google Scholar 

  16. Jensen MP, Karoly P (2001) Self-report scales and procedures for assessing pain in adults. In: Turk DC, Melzack R (eds) Handbook of pain assessment, 2nd edn. The Guilford Press, New York, pp 15–34

    Google Scholar 

  17. Arrindell WA, Ettema JHM (2003) Symptom Checklist. Handleiding bij een multidimensionele psychopathologie-indicator (Manual for a multidimensional psychopathology-indicator). (Dutch). Lisse: Swets Test Publishers

  18. Vlaeyen JWS, Kole-Snijders AMJ, Boeren RG, van Eek H (1995) Fear of movement/(re)injury in chronic low back pain and its relation to behavioral performance. Pain 62:363–372

    Article  CAS  PubMed  Google Scholar 

  19. Vlaeyen JW, Geurts SM, Kole Snijders AMJ (1990) What do chronic pain patients think of their pain? Towards a pain cognition questionnaire. Brit J Clin Psychol 29:383–394

    Article  Google Scholar 

  20. Schreurs PJG, Willige van de G, Brosschot JF, Tellegen B, Graus GMH (1993) De Utrechtse Coping Lijst: UCL. Omgaan met problemen en gebeurtenissen, herziene handleiding (The Utrecht’s Coping List: UCL. Managing problems and events, revised manual). (Dutch). Lisse: Swets Test Publishers

  21. Spinhoven P, ter Kuile M, Kole-Snijders AMJ, Hutten Mansfeld M, den Ouden DJ, Vlaeyen JWS (2004) Catastrophizing and internal pain control as mediators of outcome in the multidisciplinary treatment of chronic low back pain. Eur J Pain 8:211–219

    Article  PubMed  Google Scholar 

  22. Lynch ME, Watson CPN (2006) The pharmacotherapy of chronic pain: a review. Pain Res Manage 11:11–38

    Google Scholar 

  23. Nijs J, Meeus M, van Oosterwijck J, Roussel N, de Kooning M, Ickmans K, Matic M (2011) Treatment of central sensitization in patients with “unexplained” chronic pain: what options do we have? Expert Opin Pharmacother 12:1087–1098

    Article  CAS  PubMed  Google Scholar 

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Acknowledgments

This work was partly supported by Grünenthal BV and Stichting Beatrixoord, The Netherlands. H.R. Schiphorst Preuper was the principal investigator.

Conflict of interest

There were no conflicts of interest.

Author information

Authors and Affiliations

  1. Department of Rehabilitation Medicine, Center for Rehabilitation, University Medical Center Groningen, University of Groningen, PO box 30.002, 9750 RA, Haren, The Netherlands

    Henrica R. Schiphorst Preuper, Jan H. B. Geertzen, Pieter U. Dijkstra & Michiel F. Reneman

  2. Groningen Spine Center, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands

    Henrica R. Schiphorst Preuper, Marten van Wijhe & Michiel F. Reneman

  3. Pain Expertise Center, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands

    Marten van Wijhe

  4. Center for Rehabilitation ‘Revalidatie Friesland’, Beetsterzwaag, The Netherlands

    Anne M. Boonstra

  5. Department of Hospital and Clinical Pharmacy, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands

    Barbara H. W. Molmans

  6. Department of Oral and Maxillofacial Surgery, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands

    Pieter U. Dijkstra

Authors
  1. Henrica R. Schiphorst Preuper
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  2. Jan H. B. Geertzen
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  3. Marten van Wijhe
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  4. Anne M. Boonstra
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  5. Barbara H. W. Molmans
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  6. Pieter U. Dijkstra
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  7. Michiel F. Reneman
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Corresponding author

Correspondence to Henrica R. Schiphorst Preuper.

Additional information

Trial Registration: EudraCT-number 2008-004227-39.

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Schiphorst Preuper, H.R., Geertzen, J.H.B., van Wijhe, M. et al. Do analgesics improve functioning in patients with chronic low back pain? An explorative triple-blinded RCT. Eur Spine J 23, 800–806 (2014). https://doi.org/10.1007/s00586-014-3229-7

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  • DOI: https://doi.org/10.1007/s00586-014-3229-7

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