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Domains of chronic low back pain and assessing treatment effectiveness: a clinical perspective

journal contribution
posted on 01.02.2020, 00:00 authored by Scott TagliaferriScott Tagliaferri, Clint MillerClint Miller, Patrick OwenPatrick Owen, U H Mitchell, H Brisby, B Fitzgibbon, H Masse-Alarie, J Van Oosterwijck, Daniel BelavyDaniel Belavy
Nonspecific chronic low back pain (CLBP) is a common clinical condition that has impacts at both the individual and societal level. Pain intensity is a primary outcome used in clinical practice to quantify the severity of CLBP and the efficacy of its treatment; however, pain is a subjective experience that is impacted by a multitude of factors. Moreover, differences in effect sizes for pain intensity are not observed between common conservative treatments, such as spinal manipulative therapy, cognitive behavioral therapy, acupuncture, and exercise training. As pain science evolves, the biopsychosocial model is gaining interest in its application for CLBP management. The aim of this article is to discuss our current scientific understanding of pain and present why additional factors should be considered in conservative CLBP management. In addition to pain intensity, we recommend that clinicians should consider assessing the multidimensional nature of CLBP by including physical (disability, muscular strength and endurance, performance in activities of daily living, and body composition), psychological (kinesiophobia, fear-avoidance, pain catastrophizing, pain self-efficacy, depression, anxiety, and sleep quality), social (social functioning and work absenteeism), and health-related quality-of-life measures, depending on what is deemed relevant for each individual. This review also provides practical recommendations to clinicians for the assessment of outcomes beyond pain intensity, including information on how large a change must be for it to be considered “real” in an individual patient. This information can guide treatment selection when working with an individual with CLBP.

History

Journal

Pain practice

Volume

20

Issue

2

Pagination

211 - 225

Publisher

John Wiley & Sons

Location

Chichester, Eng.

ISSN

1530-7085

eISSN

1533-2500

Language

eng

Publication classification

C1 Refereed article in a scholarly journal