ABSTRACT
BACKGROUND: Chronic pain is a worldwide problem of healthcare along with social and economic factors. The Center for Pain Medicine (CPM) Nottwil offers individualized, interdisciplinary, multimodal pain rehabilitation based on the biopsychosocial approach. The aim of this study was to obtain a real-life analysis of chronic pain patients who were treated at the CPM Nottwil, to understand how they were treated and to analyze the long-term effects of the treatment. METHODS: In a retrospective cohort study data of all patients who underwent a first medical examination at the CPM Nottwil in 2011 were included in the study. The effectiveness of the treatment was analyzed in a 3-year follow-up measurement. The main outcome was the general well-being of the patient. RESULTS: In 2011, 628 chronic pain patients underwent a first medical examination at the CPM Nottwil. They showed low values in the dimension of general well-being and a high impairment due to severely limiting pain intensity. Although the power analysis suggested a sample size of 170 patients for the follow-up measurement, only 46 participants (responders) were included in the final analysis. Baseline characteristics between responders and non-responders of the follow-up-group showed statistically significant differences for health-related quality of life (SF-12) and the anxiety and depression scale (HADS), but not for other sample characteristics. Improvement from pretreatment to follow-up emerged in the dimension of well-being, physical well-being and pain intensity. At follow-up 30% reported being pain-free. CONCLUSION: Individualized, interdisciplinary, multimodal and mostly outpatient pain programs are an effective treatment for patients suffering from chronic pain in the long term. For the first time this effect has been proven in a clinically representative cohort. Limitations of this study are low response rates in the follow-up group and differences in baseline characteristics (anxiety, depression and quality of life) between responders and non-responders.
Subject(s)
Chronic Pain , Chronic Pain/therapy , Combined Modality Therapy , Follow-Up Studies , Humans , Quality of Life , Retrospective StudiesABSTRACT
BACKGROUND: Patients with low back pain (LBP) and movement control impairment (MVCI) show altered spinal movement patterns. Treatment that aims to change movement behaviour could benefit these patients. OBJECTIVE: To assess the effectiveness of movement control exercise (MVCE) in terms of clinically relevant measures (disability and pain) on patients with NSLBP. METHODS: A systematic review and meta-analysis were conducted. CINAHL, MEDLINE, PUBMED and PEDro databases were searched for RCT's evaluating MVCE treatment in patients with NSLBP from review inception to April 2017. Authors were contacted to obtain missing data and outcomes. PEDro was used to assess methodological quality of the studies and the GRADE approach was used to assess the overall quality of evidence Data were combined using a random effects meta-analysis and reported as standardized mean differences (SMD). RESULTS: Eleven eligible RCT's including a total of 781 patients were found. Results show 'very low to moderate quality' evidence of a positive effect of MVCE on disability, both at the end of treatment and after 12 months (SMD -0.38 95%CI -0.68, -0.09 respectively 0.37 95%CI -0.61,-0.04). Pain intensity was significantly reduced after MVCE at the end of treatment (SMD -0.39 95%CI -0.69, -0.04), but not after 12 months (SMD -0.27, 95%CI -0.62, 0.09). CONCLUSIONS: MVCE intervention for people with NSLBP and MVCI appears to be more effective in improving disability compared to other interventions, both over the short and long term. Pain was reduced only in the short term. An important factor is the initial identification of patients with MVCI. Registration of the study: The study protocol registration number is CRD42016036662 on PROSPERO.
