ABSTRACT
PURPOSE: A randomized controlled clinical trial was implemented to evaluate the effectiveness of combined mild hyperthermia therapy (body core temperature 38.4 °C) and multimodal inpatient rehabilitation for patients suffering from chronic low back pain when compared to multimodal pain therapy alone. PATIENTS AND METHODS: A total of 88 patients were randomly assigned to the combined or single therapeutic schemes according to a block randomization scheme. According to the trial inclusion criteria all patients suffered from chronic low back pain and showed morphological degeneration. All patients underwent a 12-day inpatient multimodal pain therapy, which was complemented with a 6-session schedule of mild hyperthermia therapy for the intervention group (1 h at 38.6 °C). On admission and 3 months after treatment the study patients were asked to complete an interview assessment with the Oswestry low back pain disability questionnaire (Oswestry disability index). The change in the Oswestry disability index total score (%) 3 months after versus before therapy was defined as the primary clinical endpoint of the investigation. The patients in the control group and in the intervention group had a median age of 50 years. In the intervention group 70 % of the patients were female and 55 % reported having half to full time employment compared to 55 % and 43 % in the control group, respectively. RESULTS: On admission the control patients reported a median Oswestry disability index of 64 % and on recall the same of 64 %. The intervention group showed median Oswestry disability index estimates of 60 % and 66 %, respectively. The changes in the overall Oswestry disability index after 3 months differed significantly with an estimated 6 % for the intervention group versus 0 % for the control group (Wilcoxon p = 0.050). CONCLUSION: When combined with a multimodal inpatient lower back pain functional therapy in patients showing morphological degeneration, the mild hyperthermia therapy demonstrated statistically significant, although not clinically relevant benefits in comparison to the multimodal treatment alone. However, regarding the moderate overall patient-related benefits as measured in terms of the Oswestry disability index, the benefit of the underlying multimodal therapy concept implementation must be critically discussed irrespective of its combination with mild hyperthermia therapy.
Subject(s)
Chronic Pain/therapy , Hyperthermia, Induced/methods , Low Back Pain/diagnosis , Low Back Pain/therapy , Pain Management/methods , Adult , Aged , Analgesics/therapeutic use , Cognitive Behavioral Therapy/methods , Combined Modality Therapy/methods , Directive Counseling/methods , Female , Humans , Male , Middle Aged , Pain Measurement , Psychotherapy, Group/methods , Treatment OutcomeSubject(s)
Pain Management , Physical Therapy Modalities , Analgesics, Non-Narcotic/administration & dosage , Analgesics, Non-Narcotic/therapeutic use , Back Pain/therapy , Chronic Disease , Combined Modality Therapy , Exercise Movement Techniques , Headache/therapy , Hospitalization , Humans , Ibuprofen/administration & dosage , Ibuprofen/therapeutic use , Male , Middle Aged , Musculoskeletal Manipulations , Pain/drug therapy , Pain/psychology , Physical Endurance , Quality of Life , Recovery of Function , Relaxation Therapy , Time Factors , Treatment OutcomeABSTRACT
BACKGROUND: Data of a multimodal pain management program of the multidisciplinary pain management centre at the University Hospital of Dresden is presented. Over a period of 4 weeks, supplemented by an additional week 3 months later (booster week), patients with chronic pain of different origins are being treated in groups of 12. Based on the principles of the biopsychosocial pain model and the idea of functional restoration, the program is dedicated for pain patients where outpatient treatment was insufficient. METHODS: The program was evaluated on the basis of pain intensity (NRS), pain disability (PDI), fear and depression (HADS-D), catastrophizing (CSQ) and health-related quality of life and vitality (SF-36). The data were collected at the beginning and end of the initial 4 week treatment period, at the end of the booster period as well as 6 and 12 months after the end of active treatment. RESULTS: A total of 189 patients were included in the program in the period from January 2006 until August 2008. All outcome parameter showed statistically significant improvements with small to high effect sizes (ES 0.20-0.95). The results stayed stable even 1 year after the treatment. The highest effect sizes were found in catastrophizing (ES 0.86) and average pain intensity (ES 0.95). The primary pain diagnosis (e. g. low back pain versus headache) had no impact on treatment outcome. CONCLUSION: Significant and clinically relevant improvements could be achieved with the multimodal pain management program in groups of 12 patients. The results were stable over a time period of 1 year. Pain diagnosis had no impact on the outcome.
Subject(s)
Day Care, Medical , Pain Clinics , Pain/rehabilitation , Patient Care Team , Adult , Aged , Chronic Disease , Combined Modality Therapy , Comorbidity , Depressive Disorder/epidemiology , Depressive Disorder/psychology , Depressive Disorder/rehabilitation , Disability Evaluation , Fear , Female , Follow-Up Studies , Germany , Humans , Male , Middle Aged , Pain/epidemiology , Pain/psychology , Pain Measurement , Physical Therapy Modalities , Psychotherapy , Psychotherapy, Group , Quality of Life/psychology , Young AdultABSTRACT
Under-treatment of acute postoperative pain can lead to chronic pain with neuronal plasticity and result in poor surgical outcomes. A multimodal approach is therefore necessary to reduce postoperative pain by combining various analgesics with a non-pharmacological strategy. The current use of multimodal approaches, even for the management of postoperative pain, can reduce the side effects of pharmaceutical therapy alone as well as reducing the length of hospital stay. Adequate pain control is an important prerequisite for the application of rehabilitation programmes and will thereby influence functional outcome. In addition, patient satisfaction, as a major benchmarking factor after surgical treatment, is significantly influenced by the quality of postoperative pain management.
Subject(s)
Analgesia/methods , Analgesics/therapeutic use , Orthopedic Procedures/adverse effects , Pain, Postoperative/therapy , Acupuncture Therapy , Analgesia, Patient-Controlled , Analgesics/adverse effects , Anesthesia, Conduction , Benchmarking , Combined Modality Therapy , Humans , Informed Consent , Length of Stay , Pain Measurement , Pain, Postoperative/diagnosis , Pain, Postoperative/drug therapy , Pain, Postoperative/etiology , Pain, Postoperative/physiopathology , Pain, Postoperative/psychology , Patient Satisfaction , Physical Therapy Modalities , Practice Guidelines as Topic , Relaxation Therapy , Transcutaneous Electric Nerve StimulationABSTRACT
The human cartilage and bone is characterized by a remodeling during the life, well balanced by neosynthesis and degradation of matrix components. In different joint diseases, it becomes imbalanced and the destruction of the cartilage supersedes the repair. In tissue processes in disease and in normal turnover of the matrix, these molecules are fragmented and released into surrounding fluids, in the synovial fluid, and then in the blood and the urine, where they can be detected. The quantitative measurement in the synovial fluid is more specific than in the other body fluids. The research process in recent years has suggested that these molecular markers of cartilage and bone matrix metabolism can be used to determine diagnosis, the disease severity rather than its presence or absence, the prognosis, and the response to therapy. They should help to identify the disease mechanism in different joint diseases not only on the tissue but also on the molecular level. The specific cartilage matrix markers promise to become useful tools in the future in clinical use. The research in this area is still in the early stages, with most results dated from the end of the 1980s and the 1990s.
