Simultaneous multidisciplinary care pathway for back pain: a new approach for a first-level comprehensive evaluation and treatment to guarantee adequate pain relief and recovery
DOI:
https://doi.org/10.33393/ao.2021.2225Keywords:
Back pain, Chronic pain, Multisciplinary approach, Radiofrequency, Rehabilitation, Spinal fusionAbstract
Low back pain continues to be a major clinical challenge with high direct and indirect societal costs. It is a complex disease with complex pathophysiology both for acute and chronic low back pain.
Although there is consistent evidence about multidisciplinary treatment of low back pain, several different approaches and techniques are proposed, with different results often conflicting among them. In fact, even though the multidisciplinary approach is widely accepted, it is generally applied in different steps involving only one health care providing for each approach. This approach not only does not guarantee a real multidisciplinary vision of this disease but also lacks evaluation of the dynamic changes of the disease according to real patients’ needs.
In our hospital setting we have developed a “simultaneous multidisciplinary care” of low back pain patients in order to overcome these problems and to satisfy all patients’ needs by evaluating and treating all problems causing and related to low back pain. Starting from the existing literature we propose our approach as a new pathway to treat low back patients with a simultaneous multidisciplinary approach.
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Hartvigsen J, Hancock MJ, Kongsted A, et al; Lancet Low Back Pain Series Working Group. What low back pain is and why we need to pay attention. Lancet. 2018;391(10137):2356-2367. https://doi.org/10.1016/S0140-6736(18)30480-X PMID:29573870
Koes BW, Backes D, Bindels PJE. Pharmacotherapy for chronic non-specific low back pain: current and future options. Expert Opin Pharmacother. 2018;19(6):537-545. https://doi.org/10.1080/14656566.2018.1454430 PMID:29578822
Deyo RA, Mirza SK, Turner JA, Martin BI. Overtreating chronic back pain: time to back off? J Am Board Fam Med. 2009;22(1):62-68. https://doi.org/10.3122/jabfm.2009.01.080102PMID:19124635
Rasu RS, Vouthy K, Crowl AN, et al. Cost of pain medication to treat adult patients with nonmalignant chronic pain in the United States. J Manag Care Spec Pharm. 2014;20(9):921-928. PMID:25166291
Gaskin DJ, Richard P. The economic costs of pain in the United States. J Pain. 2012;13(8):715-724. https://doi.org/10.1016/j.jpain.2012.03.009 PMID:22607834
Mayer S, Spickschen J, Stein KV, Crevenna R, Dorner TE, Simon J. The societal costs of chronic pain and its determinants: the case of Austria. PLoS One. 2019;14(3):e0213889. https://doi.org/10.1371/journal.pone.0213889 PMID:30893370
Becker A, Held H, Redaelli M, et al. Low back pain in primary care: costs of care and prediction of future health care utilization. Spine. 2010;35(18):1714-1720. https://doi.org/10.1097/BRS.0b013e3181cd656f PMID:21374895
Grimmer-Somers K, Prior M, Robertson J. Yellow flag scores in a compensable New Zealand cohort suffering acute low back pain. J Pain Res. 2008;1:15-25. https://doi.org/10.2147/JPR.S3710 PMID:21197284
Freidin MB, Lauc G, Allegri M, Primorac D, Williams FM. Using omics in chronic pain conditions to delineate mechanisms and provide new therapeutic strategies. Pain Manag. 2016;6(3):211-215. https://doi.org/10.2217/pmt.16.2 PMID:26972605
Allegri M, Montella S, Salici F, et al. Mechanisms of low back pain: a guide for diagnosis and therapy. Version 2. F1000Res. 2016Jun28 [revised 2016 Jan1]
Trbojević-Akmačić I, Vučković F, Vilaj M, et al. Plasma N-glycome composition associates with chronic low back pain. Biochim Biophys Acta, Gen Subj. 2018;1862(10):2124-2133. https://doi.org/10.1016/j.bbagen.2018.07.003 PMID:29981899
Dagostino C, Allegri M, Napolioni V, et al. CYP2D6 genotype can help to predict effectiveness and safety during opioid treatment for chronic low back pain: results from a retrospective study in an Italian cohort. Pharm Genomics Pers Med. 2018;11:179-191. https://doi.org/10.2147/PGPM.S181334 PMID:30425549
Cregg R, Russo G, Gubbay A, Branford R, Sato H. Pharmacogenetics of analgesic drugs. Br J Pain. 2013;7(4):189-208. https://doi.org/10.1177/2049463713507439 PMID:26516523
Gatzinsky K, Eldabe S, Deneuville JP, et al. Optimizing the management and outcomes of failed back surgery syndrome: a proposal of a standardized multidisciplinary team care pathway. Pain Res Manag. 2019;2019:8184592. https://doi.org/10.1155/2019/8184592PMID:31360272
Murphy SE, Blake C, Power CK, Fullen BM. The effectiveness of a stratified group intervention using the STarTBack screening tool in patients with LBP—a non randomised controlled trial. BMC Musculoskelet Disord. 2013;14(1):342. https://doi.org/10.1186/1471-2474-14-342 PMID:24308746
Storm L, Rousing R, Andersen MO, Carreon LY. Usefulness of the STarT Back Screening Tool to predict pain problems after lumbar spine surgery. Dan Med J. 2018;65(12):A5517. PMID:30511633
Karran EL, McAuley JH, Traeger AC, et al. Can screening instruments accurately determine poor outcome risk in adults with recent onset low back pain? A systematic review and meta-analysis. BMC Med. 2017;15(1):13. https://doi.org/10.1186/s12916-016-0774-4 PMID:28100231
Qaseem A, Wilt TJ, McLean RM, Forciea MA; Clinical Guidelines Committee of the American College of Physicians. Noninvasive treatments for acute, subacute, and chronic low back pain: a clinical practice guideline from the American College of Physicians. Ann Intern Med. 2017;166(7):514-530. https://doi.org/10.7326/M16-2367 PMID:28192789
Malfliet A, Ickmans K, Huysmans E, et al. Best evidence rehabilitation for chronic pain part 3: low back pain. J Clin Med. 2019;8(7):E1063. https://doi.org/10.3390/jcm8071063PMID:31331087
Robinson JP, Leo R, Wallach J, McGough E, Schatman ME. Rehabilitative treatment for chronic pain. In: Stannard C, Kalso E, Ballantyne JC, eds. Evidence-based chronic pain management. Oxford, UK: Blackwell Publishing 2010: 407-423. https://doi.org/10.1002/9781444314380.ch30
van Middelkoop M, Rubinstein SM, Kuijpers T, et al. A systematic review on the effectiveness of physical and rehabilitation interventions for chronic non-specific low back pain. Eur Spine J. 2011;20(1):19-39. https://doi.org/10.1007/s00586-010-1518-3 PMID:20640863
Willems P. Decision making in surgical treatment of chronic low back pain: the performance of prognostic tests to select patients for lumbar spinal fusion. Acta Orthop Suppl. 2013;84(349):1-35. https://doi.org/10.3109/17453674.2012.753565 PMID:23427903
Todd NV. The surgical treatment of non-specific low back pain. Bone Joint J. 2017;99-B(8):1003-1005. https://doi.org/10.1302/0301-620X.99B8.BJJ-2017-0199.R1 PMID:28768775
Stamm TA, Boesendorfer A, Omara M, Ritschl V, Štefanac S, Mosor E. Outcomes research in non-specific low back pain: knowledge transfer in clinical practice. Wien Klin Wochenschr. 2019;131(21-22):550-557. https://doi.org/10.1007/s00508-019-1523-4 PMID:31236662
Musich S, Wang SS, Slindee LB, Keown K, Hawkins K, Yeh CS. Using pain medication intensity to stratify back pain among older adults. Pain Med. 2019;20(2):252-266. https://doi.org/10.1093/pm/pny007 PMID:29394401
Juch JNS, Maas ET, Ostelo RWJG, et al. Effect of radiofrequency denervation on pain intensity among patients with chronic low back pain: the Mint Randomized Clinical Trials. JAMA. 2017;318(1):68-81. https://doi.org/10.1001/jama.2017.7918 PMID:28672319
van Kleef M, Vanelderen P, Cohen SP, Lataster A, Van Zundert J, Mekhail N. Pain originating from the lumbar facet joints. Pain Pract. 2010;10(5):459-469. https://doi.org/10.1111/j.1533-2500.2010.00393.x PMID:20667027
Gauci C. Radiofrequency neurotomy for chronic lumbar facet pain—interpreting the evidence. Pain Pract. 2010;10(3):261. https://doi.org/10.1111/j.1533-2500.2010.00369_1.xPMID:20546520
van Kuijk SMJ, Van Zundert J, Hans G, et al. Flawed study design and incorrect presentation of data negatively impact potentially useful interventional treatments for patients with low back pain: a critical review of JAMA’s MinT Study. Pain Pract. 2018;18(3):292-295. https://doi.org/10.1111/papr.12673 PMID:29377546
Nees TA, Riewe E, Waschke D, Schiltenwolf M, Neubauer E, Wang H. Multidisciplinary pain management of chronic back pain: helpful treatments from the patients’ perspective. J Clin Med. 2020;9(1):145. https://doi.org/10.3390/jcm9010145 PMID:31948111
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Accepted 2021-04-08
Published 2021-07-01
