Multidisciplinary Pain Management of Chronic Back Pain: Helpful Treatments from the Patients' Perspective

doi:10.3390/jcm9010145

. 2020 Jan 5;9(1):145.

doi: 10.3390/jcm9010145.

Multidisciplinary Pain Management of Chronic Back Pain: Helpful Treatments from the Patients' Perspective

Timo A Nees¹, Ernst Riewe¹, Daniela Waschke^{1

2}, Marcus Schiltenwolf¹, Eva Neubauer¹, Haili Wang^{1

3}

Affiliations

¹ Clinic for Orthopedics and Trauma Surgery, Center for Orthopedics, Trauma Surgery and Spinal Cord Injury, Heidelberg University Hospital, 69118 Heidelberg, Germany.
² Klinik für Gynäkologie und Geburtshilfe, Marienhaus Klinikum Hetzelstift Neustadt/Weinstraße, 67434 Neustadt an der Weinstraße, Germany.
³ Zentrum für ambulante Rehabilitation Mannheim GmbH, 68309 Mannheim, Germany.

PMID: 31948111
PMCID: PMC7019713
DOI: 10.3390/jcm9010145

Multidisciplinary Pain Management of Chronic Back Pain: Helpful Treatments from the Patients' Perspective

Timo A Nees et al. J Clin Med. 2020.

. 2020 Jan 5;9(1):145.

doi: 10.3390/jcm9010145.

Authors

Timo A Nees¹, Ernst Riewe¹, Daniela Waschke^{1

2}, Marcus Schiltenwolf¹, Eva Neubauer¹, Haili Wang^{1

3}

Affiliations

¹ Clinic for Orthopedics and Trauma Surgery, Center for Orthopedics, Trauma Surgery and Spinal Cord Injury, Heidelberg University Hospital, 69118 Heidelberg, Germany.
² Klinik für Gynäkologie und Geburtshilfe, Marienhaus Klinikum Hetzelstift Neustadt/Weinstraße, 67434 Neustadt an der Weinstraße, Germany.
³ Zentrum für ambulante Rehabilitation Mannheim GmbH, 68309 Mannheim, Germany.

PMID: 31948111
PMCID: PMC7019713
DOI: 10.3390/jcm9010145

Abstract

Multidisciplinary pain management programs (MPMP) for patients suffering from chronic back pain include a variety of treatment modalities. The patients' perceived helpfulness of these treatment modalities remains unclear. The aims of this prospective observational cohort study were to assess (i) the patients' perceived helpfulness of different treatment modalities, (ii) the influence of sociodemographic characteristics on the patient's perspective and (iii) whether treatment outcomes are affected by helpfulness ratings. Treatment modalities of this three-week MPMP consisted of individual physiotherapy, group-based physiotherapy, relaxation therapy, aquatic therapy, back education, medical training therapy, biofeedback, psychological pain therapy and music therapy. The study comprised 395 patients. The main outcome was the patients' perceived treatment helpfulness at the end of the program measured by a self-reported questionnaire ranging from 1 (not at all helpful) to 6 (extremely helpful). Secondary outcomes were treatment effects on pain, pain related disability, functional ability and level of depressive symptoms measured by self-reported questionnaires (NRS, PDI, FFbH-R, ADS-L). A total of 276 patients (22-64 years, 57% female) were available for overall analysis. Multivariate-analysis-of-variance- (MANOVA-) related results revealed that perceived treatment helpfulness (range 1-6) differed significantly between treatment modalities: individual physiotherapy (M = 5.00), group-based physiotherapy (M = 4.87), relaxation therapy (M = 4.6), aquatic therapy (M = 4.54), back education (M = 4.43), medical training therapy (M = 3.38), biofeedback (M = 3.31), psychological pain therapy (M = 3.15), music therapy (M = 3.02). Pain, pain related disability and levels of depressive symptoms significantly improved after the program (p < 0.001) whereas functional ability decreased (p < 0.01). Significant correlations were found between helpfulness ratings and sociodemographic data indicating that perceived treatment helpfulness was influenced by patient-related factors. Importantly, the degree of pain-related improvements was affected by the patients' perceived treatment helpfulness. In conclusion, patients' perceived treatment helpfulness differs significantly between treatment modalities and corresponds to treatment outcome.

Keywords: back pain; multidisciplinary pain treatment; patient satisfaction; physical therapy.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

**Figure 1**
The patients’ perceived treatment helpfulness at discharge. The number (#) of patients (= n) rating respective treatments of the multidisciplinary pain management program as being helpful (blue) or not helpful (red). Treatments were considered as helpful when rated ≥ 4 (= moderately helpful) and as not helpful when rated < 4 (rating scale from 1–6).

**Figure 2**
Mean perceived treatment helpfulness. Mean perceived helpfulness differs significantly between treatment modalities of the multidisciplinary pain management program (Analysis of variance (ANOVA): p < 0.001). Mean helpfulness ratings (±SD) ranged from 5 (±1.2) for individually-delivered physiotherapy to 3.02 (±1.47) for music therapy. Highly significant differences were observed between individually-delivered physiotherapy and back education, medical training therapy, biofeedback, psychological pain therapy as well as music therapy (Tukey’s multiple comparison: p < 0.001). Moreover, relaxation therapy, aquatic therapy and back education were perceived to be significantly more helpful than medical training therapy (Tukey’s multiple comparison: p < 0.001). Table 1 of the program (1 = not at all helpful, 2 = I don’t know, 3 = slightly helpful, 4 = moderately helpful, 5 = very helpful, 6 = extremely helpful). Data is presented as mean ± standard deviation.

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[1] Nachemson A. Recent advances in the treatment of low back pain. Int. Orthop. 1985;9:1–10. doi: 10.1007/BF00267031. - DOI - PubMed

[2] Nachemson A. Recent advances in the treatment of low back pain. Int. Orthop. 1985;9:1–10. doi: 10.1007/BF00267031. - DOI - PubMed

[3] O′Connor S.R., Tully M.A., Ryan B., Bleakley C.M., Baxter G.D., Bradley J.M., McDonough S.M. Walking exercise for chronic musculoskeletal pain: Systematic review and meta-analysis. Arch. Phys. Med. Rehabil. 2015;96:724–734. doi: 10.1016/j.apmr.2014.12.003. - DOI - PubMed

[4] O′Connor S.R., Tully M.A., Ryan B., Bleakley C.M., Baxter G.D., Bradley J.M., McDonough S.M. Walking exercise for chronic musculoskeletal pain: Systematic review and meta-analysis. Arch. Phys. Med. Rehabil. 2015;96:724–734. doi: 10.1016/j.apmr.2014.12.003. - DOI - PubMed

[5] Hayden J.A., van Tulder M.W., Tomlinson G. Systematic review: Strategies for using exercise therapy to improve outcomes in chronic low back pain. Ann. Intern. Med. 2005;142:776–785. doi: 10.7326/0003-4819-142-9-200505030-00014. - DOI - PubMed

[6] Hayden J.A., van Tulder M.W., Tomlinson G. Systematic review: Strategies for using exercise therapy to improve outcomes in chronic low back pain. Ann. Intern. Med. 2005;142:776–785. doi: 10.7326/0003-4819-142-9-200505030-00014. - DOI - PubMed

[7] Van Middelkoop M., Rubinstein S.M., Kuijpers T., Verhagen A.P., Ostelo R., Koes B.W., van Tulder M.W. A systematic review on the effectiveness of physical and rehabilitation interventions for chronic non-specific low back pain. Eur. Spine J. 2011;20:19–39. doi: 10.1007/s00586-010-1518-3. - DOI - PMC - PubMed

[8] Van Middelkoop M., Rubinstein S.M., Kuijpers T., Verhagen A.P., Ostelo R., Koes B.W., van Tulder M.W. A systematic review on the effectiveness of physical and rehabilitation interventions for chronic non-specific low back pain. Eur. Spine J. 2011;20:19–39. doi: 10.1007/s00586-010-1518-3. - DOI - PMC - PubMed

[9] Van Tulder M.W., Ostelo R., Vlaeyen J.W., Linton S.J., Morley S.J., Assendelft W.J. Behavioral treatment for chronic low back pain: A systematic review within the framework of the Cochrane Back Review Group. Spine. 2000;25:2688–2699. doi: 10.1097/00007632-200010150-00024. - DOI - PubMed

[10] Van Tulder M.W., Ostelo R., Vlaeyen J.W., Linton S.J., Morley S.J., Assendelft W.J. Behavioral treatment for chronic low back pain: A systematic review within the framework of the Cochrane Back Review Group. Spine. 2000;25:2688–2699. doi: 10.1097/00007632-200010150-00024. - DOI - PubMed

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Multidisciplinary Pain Management of Chronic Back Pain: Helpful Treatments from the Patients' Perspective

Affiliations

Multidisciplinary Pain Management of Chronic Back Pain: Helpful Treatments from the Patients' Perspective

Authors

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Abstract

Conflict of interest statement

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