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.