Transcript Slide 1
Low Back Pain Remedies and Procedures: Helpful or Harmful? ® Lauren Lyons, Terrell Benold, MD, Sandra Burge, PhD The University of Texas Health Science Center at San Antonio Introduction Method Low back pain is considered chronic when it persists for longer than three months. It is a prevalent and debilitating ailment that affects the daily life and activities of many people. Additionally, it is costly; Americans spend up to $50 million a year on this medical problem alone (www.ninds.com). Various procedures and treatments have been developed in the attempt to treat low back pain but are these procedures and remedies actually beneficial? Previous investigators examined the effectiveness of key treatments such as physical therapy, injections, and spinal fusion surgical procedures. Cherkin et. al studied the effectiveness of physical therapy and chiropractic treatment versus minimal intervention, an educational booklet.(ref) They found that patients receiving physical therapy and chiropractic treatment had slightly better outcomes (measured by bothersome symptoms and function) than patients who received only an educational booklet. Garvey et. al found that drug injection therapy had about the same effectiveness as therapy without injected medication. (ref) Bentsen et. al looked at patients who underwent spinal fusion surgery versus those who did not have surgery. (ref)They found that the postoperative patients experienced less pain and greater mental and physical health. In this study, we examine how pain management procedures correlate with changes in pain, physical functioning, role function, general health status, and depression. Table 1: Treatments & Outcomes Pain Clinic Physical Therapy Exercise Ice/Heat Subjects. •Student research assistants enrolled 258 adult patients with low back pain from 9 outpatient clinics across Texas, and completed followup data collection one year later with 159 patients (62% followup rate). •Patients were eligible if they had low back pain for 3 months or longer, and were excluded if they were pregnant or had a diagnosis of cancer. Procedure and Measurement. •Students gathered data from patient surveys and medical records at enrollment and followup. •A 6-page patient survey addressed demographic characteristics, pain duration, frequency and severity, physical functioning and general health, anxiety, depression, substance abuse, and risk for opioid misuse. •From participants’ medical records, students gathered information about causes of low back pain, treatments for pain (including medications, procedures, and surgeries), comorbidities, and Body Mass Index (BMI). •To assess changes over time, investigators created change-scores for pain, physical function, role function, and general health, subtracting baseline levels from one-year followup levels of these scales. Pain Physical Function Role Function Health Score Depression Near-significant increase p= .053 No significance No significance No significance No significance No significance Significant decrease p=.023 No significance No significance Significant increase p=.022 No significance No significance No significance No significance No significance Results This analysis includes 159 subjects. 72.3% were women; 27.7% were Hispanic and 18.2% were African American. Average age was 54.01. Figure 1 shows the various treatments that the patients received in the past 12 months. Table 1 shows the significant relationships between treatments and one-year changes in pain, function, and health outcomes. References Acknowledgements This study was conducted in the Residency Research Network of Texas (RRNeT) with support from the Dean’s Office, School of Medicine, UTHSCSA; the Texas Academy of Family Physicians; the South Texas Area Health Education Center; the National Center for Research Resources (Award # UL 1RR025767); and the Health Resources and Services Administration (Award # D54HP16444). The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Center for Research Resources of the National Institutes of Health. Significant decrease p=.002 Significant increase p=.033 No significance No significance No significance Conclusions In this sample, use of pain clinic, physical therapy, and ice/heat were associated with worsening pain, functioning, and depression. Only exercise was associated with an improvement in subjective health. These findings are in contrast with previous research that found a slight advantage for doing physical therapy or chiropractic treatment. (ref) The significant increase in pain following pain clinic treatment is puzzling because this is the opposite of what is expected. In this case, the intervention came first and the worsening symptoms followed. Why have symptoms worsened in patients who received these treatments? Cause-and-effect is unclear; it is possible that flare-ups in pain or worsening function caused these patients to seek more treatments; or the treatments could have exacerbated symptoms. Increase in depression could be due to patients feeling hopeless and upset when treatments do not help. Primary care physicians should closely monitor patients who are referred for procedural treatments to determine changes in function and mood, and redirect them when treatments are ineffective.