BACKGROUND: Little is known about the outcome quality of treatment for chronic low back pain under primary care conditions in Germany. METHODS: All physicians (2100) of middle Franconia, a region of Bavaria with 1.6 million inhabitants, involved in outpatient management were asked to include consecutively patients who suffered from low back pain of at least 4 weeks duration without decreasing intensity. Before and after a 6-month interval patients documented the following outcome data in a questionnaire: pain intensity during the last 24 hours (numerical rating scale), pain-dependent disability (Brief Pain Inventory, German version), health-related quality of life (SF-36, German version), depression (Allgemeine Depressionsskala), pain chronification state (Mainz Pain Staging System) and the days of inability to work within 3 months before start and end of the interval. Treatment of patients was not standardized and included the natural spectrum of non-surgical therapies for low back pain except multimodal pain therapy programs. RESULTS: Thirty-five physicians participated in the study. "Before and after" data of 157 patients (43+/-12 years) could be analysed. Initially 20% were classified in pain chronification state I, 57% in state II and 23% in state III. The pain intensity, pain-dependent disability, depression and quality of life improved significantly but mean differences and effect sizes were small (p<0.41). Less than one third of patients improved by 30% or more from baseline or by one step in the chronification state of pain. Days off work did not change significantly. Predictors for positive therapy response could not be identified. CONCLUSIONS: Monodisciplinary treatment procedures are not sufficient to ameliorate problems of patients in advanced chronification states of back pain.
BACKGROUND: Little is known about the outcome quality of treatment for chronic low back pain under primary care conditions in Germany. METHODS: All physicians (2100) of middle Franconia, a region of Bavaria with 1.6 million inhabitants, involved in outpatient management were asked to include consecutively patients who suffered from low back pain of at least 4 weeks duration without decreasing intensity. Before and after a 6-month interval patients documented the following outcome data in a questionnaire: pain intensity during the last 24 hours (numerical rating scale), pain-dependent disability (Brief Pain Inventory, German version), health-related quality of life (SF-36, German version), depression (Allgemeine Depressionsskala), pain chronification state (Mainz Pain Staging System) and the days of inability to work within 3 months before start and end of the interval. Treatment of patients was not standardized and included the natural spectrum of non-surgical therapies for low back pain except multimodal pain therapy programs. RESULTS: Thirty-five physicians participated in the study. "Before and after" data of 157 patients (43+/-12 years) could be analysed. Initially 20% were classified in pain chronification state I, 57% in state II and 23% in state III. The pain intensity, pain-dependent disability, depression and quality of life improved significantly but mean differences and effect sizes were small (p<0.41). Less than one third of patients improved by 30% or more from baseline or by one step in the chronification state of pain. Days off work did not change significantly. Predictors for positive therapy response could not be identified. CONCLUSIONS: Monodisciplinary treatment procedures are not sufficient to ameliorate problems of patients in advanced chronification states of back pain.
Authors: Christian Alexander Fischer; Eva Neubauer; Hanne S Adams; Marcus Schiltenwolf; Haili Wang Journal: Int Orthop Date: 2013-11-29 Impact factor: 3.075
Authors: Harald J Hamre; Claudia M Witt; Gunver S Kienle; Anja Glockmann; Renatus Ziegler; Stefan N Willich; Helmut Kiene Journal: J Pain Res Date: 2009-06-25 Impact factor: 3.133