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Deconstructing Chronic Low Back Pain in the Older Adult – Part I: Hip Osteoarthritis

By |January 26, 2016|Low Back Pain|

Deconstructing Chronic Low Back Pain in the Older Adult – Step by Step Evidence and Expert-Based Recommendations for Evaluation and Treatment.
Part I: Hip Osteoarthritis

The Chiro.Org Blog

SOURCE:   Pain Medicine 2015 (May); 16 (5): 886-897 ~ FULL TEXT

Debra K. Weiner, Meika Fang, Angela Gentili,
Dr. Gary Kochersberger, Zachary A. Marcum,
Michelle I. Rossi, Todd P. Semla, Joseph Shega

Geriatric Research, Education and Clinical Center,
VA Pittsburgh Healthcare System,
Pittsburgh, Pennsylvania, USA.


This is just one from a series of 10 articles titled:

Deconstructing Chronic Low Back Pain in the Older Adult

OBJECTIVE:   To present the first in a series of articles designed to deconstruct chronic low back pain (CLBP) in older adults. The series presents CLBP as a syndrome, a final common pathway for the expression of multiple contributors rather than a disease localized exclusively to the lumbosacral spine. Each article addresses one of twelve important contributors to pain and disability in older adults with CLBP. This article focuses on hip osteoarthritis (OA).

METHODS:   The evaluation and treatment algorithm, a table articulating the rationale for the individual algorithm components, and stepped-care drug recommendations were developed using a modified Delphi approach. The Principal Investigator, a five-member content expert panel and a nine-member primary care panel were involved in the iterative development of these materials. The algorithm was developed keeping in mind medications and other resources available within Veterans Health Administration (VHA) facilities. As panelists were not exclusive to the VHA, the materials can be applied in both VHA and civilian settings. The illustrative clinical case was taken from one of the contributor’s clinical practice.

RESULTS:   We present an algorithm and supportive materials to help guide the care of older adults with hip OA, an important contributor to CLBP. The case illustrates an example of complex hip-spine syndrome, in which hip OA was an important contributor to disability in an older adult with CLBP.

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Deconstructing Chronic Low Back Pain in the Older Adult – Introduction

By |January 23, 2016|Low Back Pain|

Deconstructing Chronic Low Back Pain in the Older Adult – Shifting the Paradigm from the Spine to the Person – Introduction

The Chiro.Org Blog

SOURCE:   Pain Medicine 2015 (May); 16 (5): 881-885 ~ FULL TEXT

Debra K. Weiner

Geriatric Research, Education & Clinical Center,
VA Pittsburgh Healthcare System,
University of Pittsburgh,
Pittsburgh, PA, USA.


This is just one from a series of 10 articles titled:

Deconstructing Chronic Low Back Pain in the Older Adult

Over the past decade, the estimated prevalence of low back pain (LBP) among older adults (typically defined as those ≥age 65) has more than doubled [1], and the utilization of advanced spinal imaging (e.g., computerized tomography (CT), magnetic resonance imaging [MRI]) and procedures guided by this imaging (e.g., epidural corticosteroids, spinal surgery) have continued to skyrocket. [1-3]

Treatment outcomes, however, have not improved apace. Why? Part of the answer lies in the fact that treatment may in part be misdirected.

This issue of Pain Medicine contains the first in a series of articles on how to systematically and comprehensively rethink our approach to evaluating and designing management for older adults with chronic low back pain (CLBP). The series is entitled “Deconstructing Chronic Low Back Pain in the Older Adult: Step-by-Step Evidence and Expert-Based Recommendations for Evaluation and Treatment” and the article in this issue focuses on hip osteoarthritis (OA), an important potential contributor to CLBP in older adults.

KEYWORDS:   Back Pain; Chronic Low Back Pain; Chronic Pain; Elderly; Geriatric; Homeostenosis; Low Back Pain; Lumbar; Magnetic Resonance Imaging; Older Adults; Pain Management; Treatment Outcome

 

From the FULL TEXT Article:

Current Practice

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Back and Pelvic Pain in an Underserved United States Pregnant Population

By |January 19, 2016|Low Back Pain, Pregnancy|

Back and Pelvic Pain in an Underserved United States Pregnant Population: A Preliminary Descriptive Survey

The Chiro.Org Blog

SOURCE:   J Manipulative Physiol Ther. 2007 (Feb); 30 (2): 130–134

Clayton D. Skaggs, DC, Heidi Prather, DO,
Gilad Gross, MD, James W. George, DC,
Paul A. Thompson, PhD, D. Michael Nelson, MD, PhD

Department of Obstetrics and Gynecology,
Washington University School of Medicine,
St Louis, MO, USA.
skaggsdc@swbell.net

OBJECTIVE:   The objective of this study was to identify the prevalence of back pain and treatment satisfaction in a population of low-socioeconomic pregnant women.

METHODS:   This study used a cross-sectional design to determine the prevalence of self-reported musculoskeletal pain in pregnancy for 599 women. Women completed an author-generated musculoskeletal survey in the second trimester of their pregnancy that addressed pain history, duration, location, and intensity, as well as activities of daily living, treatment frequency, and satisfaction with treatment.

RESULTS:   Sixty-seven percent of the total population reported musculoskeletal pain, and nearly half presented with a multi-focal pattern of pain that involved 2 or more sites. Twenty-one percent reported severe pain intensity rated on a numerical rating scale. Eighty percent of women experiencing pain slept less than 4 hours per night and 75% of these women took pain medications. Importantly, 85% of the women surveyed perceived that they had not been offered treatment for their musculoskeletal disorders.

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A Non-surgical Approach to the Management of Lumbar Spinal Stenosis

By |January 17, 2016|Spinal Stenosis|

A Non-surgical Approach to the Management of Lumbar Spinal Stenosis: A Prospective Observational Cohort Study

The Chiro.Org Blog

SOURCE:   BMC Musculoskelet Disord. 2006 (Feb 23); 7: 16

Donald R Murphy, Eric L Hurwitz,
Amy A Gregory, and Ronald Clary

Rhode Island Spine Center,
Pawtucket, RI 02860, USA.

BACKGROUND:   While it is widely held that non-surgical management should be the first line of approach in patients with lumbar spinal stenosis (LSS), little is known about the efficacy of non-surgical treatments for this condition. Data are needed to determine the most efficacious and safe non-surgical treatment options for patients with LSS. The purpose of this paper is to describe the clinical outcomes of a novel approach to patients with LSS that focuses on distraction manipulation (DM) and neural mobilization (NM).

METHODS:   This is a prospective consecutive case series with long term follow up (FU) of fifty-seven consecutive patients who were diagnosed with lumbar spinal stenosis (LSS). Two were excluded because of absence of baseline data or failure to remain in treatment to FU. Disability was measured using the Roland Morris Disability Questionnaire (RM) and pain intensity was measured using the Three Level Numerical Rating Scale (NRS). Patients were also asked to rate their perceived percentage improvement.

RESULTS:   The mean patient-rated percentage improvement from baseline to the end to treatment was 65.1%. The mean improvement in disability from baseline to the end of treatment was 5.1 points. This was considered to be clinically meaningful. Clinically meaningful improvement in disability from baseline to the end of treatment was seen in 66.7% of patients. The mean improvement in “on average” pain intensity was 1.6 points. This did not reach the threshold for clinical meaningfulness. The mean improvement in “at worst” pain was 3.1 points. This was considered to be clinically meaningful. The mean duration of FU was 16.5 months. The mean patient-rated percentage improvement from baseline to long term FU was 75.6%. The mean improvement in disability was 5.2 points. This was considered to be clinically meaningful. Clinically meaningful improvement in disability was seen in 73.2% of patients. The mean improvement in “on average” pain intensity from baseline to long term FU was 3.0 points. This was considered to be clinically meaningful. The mean improvement in “at worst” pain was 4.2 points. This was considered to be clinically meaningful. Only two patients went on to require surgery. No major complications to treatment were noted.

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Overtreating Chronic Back Pain: Time to Back Off?

By |January 16, 2016|Evidence-based Medicine, Low Back Pain|

Overtreating Chronic Back Pain: Time to Back Off?

The Chiro.Org Blog

SOURCE:   J Am Board Fam Med. 2009 (Jan); 22 (1): 62–68

Richard A. Deyo, M.D., M.P.H., Sohail K. Mirza, M.D., M.P.H.,
Judith A. Turner, Ph.D., and Brook I. Martin, M.P.H.

Department of Medicine,
Oregon Health and Science University,
Portland, OR, USA.
deyor@ohsu.edu

Chronic back pain is among the most common patient complaints. Its prevalence and impact have spawned a rapidly expanding range of tests and treatments. Some of these have become widely used for indications that are not well validated, leading to uncertainty about efficacy and safety, increasing complication rates, and marketing abuses.

Recent studies document a

629% increase in Medicare expenditures for epidural steroid injections;

a 423% increase in expenditures for opioids for back pain;

a 307% increase in the number of lumbar magnetic resonance images among Medicare beneficiaries;

and a 220% increase in spinal fusion surgery rates.

The limited studies available suggest that these increases have not been accompanied by population-level improvements in patient outcomes or disability rates. We suggest a need for a better understanding of the basic science of pain mechanisms, more rigorous and independent trials of many treatments, a stronger regulatory stance toward approval and post-marketing surveillance of new drugs and devices for chronic pain, and a chronic disease model for managing chronic back pain.

 

From the FULL TEXT Article:

Introduction

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