Pain and functional recovery from chronic low back pain over 12 months: implications for osteopathic medicine

John C Licciardone, Vishruti Pandya, John C Licciardone, Vishruti Pandya

Abstract

Context: Although low back pain is a common medical condition that often progresses to become a chronic problem, little is known about the likelihood of recovery from chronic low back pain (CLBP).

Objectives: This study aimed to measure the risk of recovery from CLBP based on low back pain intensity and back-related functioning measures reported by participants within a pain research registry over 12 months of observation and to consider the implications for osteopathic medicine.

Methods: A total of 740 participants with CLBP in the Pain Registry for Epidemiological, Clinical, and Interventional Studies and Innovation in the United States were studied between April 2016 and October 2021. Inception cohorts for pain recovery and functional recovery were assembled from the participants who did not meet the recovery criteria at registry enrollment. The pain recovery criterion was having a score of ≤1/10 on a numerical rating scale for low back pain intensity, and the functional recovery criterion was having a score of ≤4/24 on the Roland-Morris Disability Questionnaire. A total of 737 and 692 participants were included in the inception cohorts for pain recovery and functional recovery, respectively. Participants provided follow-up data at quarterly encounters over 12 months to determine if they achieved and maintained a pain or functional recovery from CLBP over the entire period of observation. Logistic regression was utilized to identify factors associated with recovery.

Results: The mean age of the participants at baseline was 52.9 years (SD, 13.1 years) and 551 (74.5%) were female. No participant reported a pain recovery that was maintained over all four quarterly encounters, whereas 16 participants (2.3%; 95% CI, 1.2-3.4%) maintained a functional recovery. Having high levels of pain self-efficacy (OR, 17.50; 95% CI, 2.30-133.23; p=0.006) and being Hispanic (OR, 3.55; 95% CI, 1.11-11.37; p=0.03) were associated with functional recovery, and high levels of pain catastrophizing (OR, 0.15; 95% CI, 0.03-0.65; p=0.01) and having chronic widespread pain (OR, 0.23; 95% CI, 0.08-0.66; p=0.007) were inversely associated with functional recovery. The findings for pain self-efficacy and Hispanic ethnicity remained significant in the multivariate analysis that adjusted for potential confounders.

Conclusions: The absence of pain recovery and the low likelihood of functional recovery observed in our study suggests that osteopathic physicians should embrace a biopsychosocial approach to CLBP management and work with patients to set realistic expectations based on more pragmatic outcome measures, such as those that address health-related quality of life. The findings also suggest the potential importance of patient education and counseling to enhance pain self-efficacy.

Keywords: chronic low back pain; pain research registry; physical function; recovery.

© 2022 the author(s), published by De Gruyter, Berlin/Boston.

References

    1. Vos, T, Flaxman, AD, Naghavi, M, Lozano, R, Michaud, C, Ezzati, M, et al.. Years lived with disability (YLDs) for 1160 sequelae of 289 diseases and injuries 1990-2010: a systematic analysis for the Global Burden of Disease Study 2010. Lancet 2013;380:2163–96.
    1. Roland, M, Morris, R. A study of the natural history of back pain. Part I: development of a reliable and sensitive measure of disability in low-back pain. Spine 1983;8:141–4. .
    1. Kamper, SJ, Maher, CG, Herbert, RD, Hancock, MJ, Hush, JM, Smeets, RJ. How little pain and disability do patients with low back pain have to experience to feel that they have recovered? Eur Spine J 2010;19:1495–501. .
    1. Ballantyne, JC, Sullivan, MD. Intensity of chronic pain--the wrong metric? N Engl J Med 2015;373:2098–9. .
    1. Levy, N, Sturgess, J, Mills, P. “Pain as the fifth vital sign” and dependence on the “numerical pain scale” is being abandoned in the US: why? Br J Anaesth 2018;120:435–8. .
    1. Rudd, RA, Aleshire, N, Zibbell, JE, Gladden, RM. Increases in drug and opioid overdose deaths--United States, 2000-2014. MMWR Morb Mortal Wkly Rep 2016;64:1378–82. .
    1. Sullivan, MD, Ballantyne, JC. Must we reduce pain intensity to treat chronic pain? Pain 2016;157:65–9. .
    1. Licciardone, JC. A national study of primary care provided by osteopathic physicians. J Am Osteopath Assoc 2015;115:704–13. .
    1. Seffinger, MA, Hruby, RJ, Rogers, FJ, Willard, FH, Licciardone, J, Jones, JMIII, et al.. Philosophy of osteopathic medicine. In: Seffinger, MA, Hruby, R, Willard, FH, Licciardone, J, editors. Foundations of osteopathic medicine: philosophy, science, clinical applications, and research, 4th ed. Philadelphia, PA: Wolters Kluwer; 2018:2–18 pp.
    1. Deyo, RA, Dworkin, SF, Amtmann, D, Andersson, G, Borenstein, D, Carragee, E, et al.. Report of the NIH Task Force on research standards for chronic low back pain. J Pain 2014;15:569–85. .
    1. PRECISION Pain Research Registry (PRECISION); 2021. Available from: .
    1. Sullivan, MJ. The Pain Catastrophizing Scale: User Manual. Montreal, QC: McGill University; 2009.
    1. Nicholas, MK. The pain self-efficacy questionnaire: Taking pain into account. Eur J Pain 2007;11:153–63. .
    1. Gatchel, RJ. Comorbidity of chronic pain and mental health disorders: the biopsychosocial perspective. Am Psychol 2004;59:795–805. .
    1. Minotti, D, Licciardone, JC, Kearns, C, Gatchel, RJ. Osteopathic medicine: approach to pain management. Pract Pain Manag 2010;28–29:37–8.
    1. Licciardone, JC, Brimhall, AK, King, LN. Osteopathic manipulative treatment for low back pain: a systematic review and meta-analysis of randomized controlled trials. BMC Muscoskel Disord 2005;6:43. .
    1. Franke, H, Franke, JD, Fryer, G. Osteopathic manipulative treatment for nonspecific low back pain: a systematic review and meta-analysis. BMC Muscoskel Disord 2014;15:286. .
    1. Licciardone, JC, Minotti, DE, Gatchel, RJ, Kearns, CM, Singh, KP. Osteopathic manual treatment and ultrasound therapy for chronic low back pain: a randomized controlled trial. Ann Fam Med 2013;11:122–9. .
    1. Clinical Guideline Subcommittee on Low Back Pain. American Osteopathic Association guidelines for osteopathic manipulative treatment (OMT) for patients with low back pain. J Am Osteopath Assoc 2010;110:653–66.
    1. Task Force on the Low Back Pain Clinical Practice Guideline. American Osteopathic Association guidelines for osteopathic manipulative treatment (OMT) for patients with low back pain. J Am Osteopath Assoc 2016;116:536–49.
    1. Licciardone, JC, Gatchel, RJ. Osteopathic medical care with and without osteopathic manipulative treatment in patients with chronic low back pain: a pain registry-based study. J Am Osteopath Assoc 2020;120:64–73. .
    1. Licciardone, JC, Aryal, S. Patient-centered care or osteopathic manipulative treatment as mediators of clinical outcomes in patients with chronic low back pain. J Osteopath Med 2021;121:795–804. .
    1. Licciardone, JC, Gatchel, RJ, Aryal, S. Recovery from chronic low back pain after osteopathic manipulative treatment: a randomized controlled trial. J Am Osteopath Assoc 2016;116:144–55. .
    1. Kuchera, ML. Osteopathic manipulative medicine considerations in patients with chronic pain. J Am Osteopath Assoc 2005;105:S29–36.
    1. Kuchera, ML. Applying osteopathic principles to formulate treatment for patients with chronic pain. J Am Osteopath Assoc 2007;107:ES28–S38.

Source: PubMed

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