scholarly journals Analysis of State Insurance Coverage for Nonpharmacologic Treatment of Low Back Pain as Recommended by the American College of Physicians Guidelines

2019 ◽  
Vol 8 ◽  
pp. 216495611985562 ◽  
Author(s):  
Robert Bonakdar ◽  
Dania Palanker ◽  
Megan M Sweeney
Keyword(s):  
Chronic Pain ◽  
Low Back Pain ◽  
Back Pain ◽  
Spinal Manipulation ◽  
Tai Chi ◽  
Insurance Coverage ◽  
Low Back ◽  
Chronic Pain Management ◽  
Multidisciplinary Rehabilitation ◽  
Nonpharmacologic Treatment

Background In 2017, the American College of Physicians (ACP) released guidelines encouraging nonpharmacologic treatment of chronic low back pain (LBP). These guidelines recommended utilization of treatments including multidisciplinary rehabilitation, acupuncture, mindfulness-based stress reduction (MBSR), tai chi, yoga, progressive relaxation, biofeedback, cognitive behavioral therapy (CBT), and spinal manipulation. Objective We aimed to determine status of insurance coverage status for multiple nonpharmacological pain therapies based on the 2017 Essential Health Benefits (EHB) benchmark plans across all states. Methods The 2017 EHB benchmark plans represent the minimum benefits required in all new policies in the individual and small group health insurance markets and were reviewed for coverage of treatments for LBP recommended by the ACP guidelines. Additionally, plans were reviewed for limitations and exclusionary criteria. Results In nearly all state-based coverage policies, chronic pain management and multidisciplinary rehabilitation were not addressed. Coverage was most extensive (supported by 46 states) for spinal manipulation. Acupuncture, massage, and biofeedback were each covered by fewer than 10 states, while MBSR, tai chi, and yoga were not covered by any states. Behavioral health treatment (CBT and biofeedback) coverage was often covered solely for mental health diagnoses, although excluded for treating LBP. Conclusion Other than spinal manipulation, evidence-based, nonpharmacological therapies recommended by the 2017 ACP guidelines were routinely excluded from EHB benchmark plans. Insurance coverage discourages multidisciplinary rehabilitation for chronic pain management by providing ambiguous guidelines, restricting ongoing treatments, and excluding behavioral or complementary therapy despite a cohesive evidence base. Better EHB plan coverage of nondrug therapies may be a strategy to mitigate the opioid crisis. Recommendations that reflect current research-based findings are provided to update chronic pain policy statements.

scholarly journals Non-Invasive Treatment To Reduce Low Back Pain Among Treatment Acupunture, Massage, Spinal Manipulation, Yoga, And Tai Chi A Systematic Review

2018 ◽  
Vol 1 (1) ◽  
Author(s):  
Cecep Eli Kosasih ◽  
Tetti Solehati ◽  
Agus Cakrahayat
Keyword(s):  
Low Back Pain ◽  
Back Pain ◽  
Spinal Manipulation ◽  
English Language ◽  
Tai Chi ◽  
Age Factors ◽  
Low Back ◽  
Invasive Treatment ◽  
Non Invasive ◽  
Long Time

Background: Low back pain (LBP) is one of the many spinal cord-positioning conditions commonly experienced by adults. Age factors affect the seriousness of trauma to the spine as in patients with osteoporosis under unusual conditions caused by radiculopathy or spinal stenosis, fracture, tumor or infection. This article aimed to identify the most effective non-invasive treatment in treating pain in Low Back Pain (LBP). Methods: cirtical review was used in making this article. Articles were collected through Medline, Google Scholar, Science Direct, Pubmed databases using the keywords: treatment, non-invasive, Low Back Pain from the quantitative studies. The selected articles were those that met the criteria based on PICO, published in the 2010-2017, and used English language. Articles were then evaluated using critical appraisal and PRISMA guides. Based on the evaluation, there are 6 (six) articles that match the purpose and criteria of review. From the literature search results found ways to reduce pain through non-invasive treatment such as Acupunture, Massage, Spinal Manipulation and Yoga can reduce LBP pain. Conclusion: The result of the literature that the most effective method of reducing pain is spinal manipulation where the effect of reducing pain can be maintained for a long time and is more applicable because without the use of aids, nevertheless treatment combined with other treatments and done on an ongoing basis will better results.Keywords: treatment, non infasif, Low Back Pain

A Meta-analysis：Therapeutic Effect of Tai Chi on Low Back Pain

2017 ◽  
Vol 27 (4) ◽  
pp. 60
Author(s):  
Xiang LI ◽  
Xiangbin WANG ◽  
Tianjiao LI ◽  
Jian HE ◽  
Meijin HOU
Keyword(s):  
Low Back Pain ◽  
Back Pain ◽  
Tai Chi ◽  
Low Back

scholarly journals Brain-Derived Neurotrophic Factor and Immune Cells in Osteoarthritis, Chronic Low Back Pain, and Chronic Widespread Pain Patients: Association with Anxiety and Depression

Medicina ◽  
2021 ◽  
Vol 57 (4) ◽  
pp. 327
Author(s):  
Dominique Josephine Dimmek ◽  
Christoph Korallus ◽  
Sabine Buyny ◽  
Gutenbrunner Christoph ◽  
Ralf Lichtinghagen ◽  
...  
Keyword(s):  
Chronic Pain ◽  
Low Back Pain ◽  
Back Pain ◽  
Immune Cells ◽  
Chronic Widespread Pain ◽  
Anxiety And Depression ◽  
Low Back ◽  
Widespread Pain ◽  
Chronic Pain Patients ◽  
Pain Patients

Background and Objectives: Musculoskeletal dysfunction can induce several types of chronic pain syndromes. It is of particular interest to elucidate the pathomechanism of different forms of chronic pain. It is possible that patients who have developed chronic widespread pain (CWP) may endure different pathomechanisms as compared to those who suffer from local pain (osteoarthritis, OA) and regional pain (chronic low back pain, cLBP), especially with regard to pain regulation and its related biomediators. The aim of this study was to determine the differences in pathomechanisms among these patients by measuring pain-related biomediators, particularly brain-derived neurotrophic factor (BDNF). Additionally, subpopulations of immune cells were determined in parallel. Materials and Methods: Patients and healthy subjects (HSs) were recruited (age and gender-matched). BDNF was measured from serum samples of patients and HSs and the data of body composition parameters were recorded. Additionally, both patients and HSs were asked to fill in questionnaires related to pain intensity, anxiety, and depression. Results: Our results highlight that the levels of both free and total BDNF are significantly lower in pain patients compared to HSs, with p values of 0.041 and 0.024, respectively. The number of CD3− CD56bright natural killer (NK) cells shows significant differences between the groups. Comparing all chronic pain patients with HSs reveals a significantly lower number of CD4+ CD8+ T cells (p = 0.031), CD3− CD56bright NK cells (p = 0.049) and CD20+ CD3− cells (p = 0.007). Conclusions: To conclude, it seems that a general conformity between the pathomechanisms of different chronic pain diseases exists, although there are unique findings only in specific chronic pain patients.

scholarly journals Changes in pain sensitivity and spinal stiffness in relation to responder status following spinal manipulative therapy in chronic low Back pain: a secondary explorative analysis of a randomized trial

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Casper Glissmann Nim ◽  
Gregory Neil Kawchuk ◽  
Berit Schiøttz-Christensen ◽  
Søren O’Neill
Keyword(s):  
Low Back Pain ◽  
Back Pain ◽  
Randomized Trial ◽  
Clinical Improvement ◽  
Spinal Manipulation ◽  
Pain Sensitivity ◽  
Spinal Manipulative Therapy ◽  
Low Back ◽  
Manipulative Therapy ◽  
Pressure Pain Thresholds

Abstract Background In a prior randomized trial, we demonstrated that participants receiving spinal manipulative therapy at a pain-sensitive segment instead of a stiff segment experienced increased mechanical pressure pain thresholds. We hypothesized that the targeted segment mediated this increase through a segment-dependent neurophysiological reflective pathway. Presently, it is not known if this decrease in pain sensitivity is associated with clinical improvement. Therefore, we performed an explorative analysis to examine if changes in experimental pain sensitivity (mechanical and thermal) and lumbar stiffness were further dependent on clinical improvement in disability and patient-reported low back pain. Methods This study is a secondary explorative analysis of data from the randomized trial that compared 132 participants with chronic low back pain who received lumbar spinal manipulative therapy applied at either i) the stiffest segment or ii) the segment having the lowest pain threshold (i.e., the most pain-sensitive segment). We collected data at baseline, after the fourth session of spinal manipulation, and at 14-days follow-up. Participants were dichotomized into responders/non-responders using different clinical variables (disability and patient-reported low back pain) with varying threshold values (0, 30, and 50% improvement). Mixed models were used to assess changes in experimental outcomes (stiffness and pain sensitivity). The fixed interaction terms were time, segment allocation, and responder status. Results We observed a significant increase in mechanical pressure pain thresholds for the group, which received spinal manipulative therapy at the most pain-sensitive segment independent of whether they improved clinically or not. Those who received spinal manipulation at the stiffest segment also demonstrated increased mechanical pain sensitivity, but only in the subgroup with clinical improvement. We did not observe any changes in lumbar stiffness. Conclusion Our results suggest the existence of two different mechanistic pathways associated with the spinal manipulation target. i) A decrease of mechanical pain sensitivity independent of clinical outcome (neurophysiological) and ii) a decrease as a reflection of the clinical outcome. Together, these observations may provide a novel framework that improves our understanding of why some respond to spinal manipulative therapy while others do not. Trial registration ClinicalTrials.gov identifier: NCT04086667 registered retrospectively September 11th 2019.

scholarly journals Estimating the population health burden of musculoskeletal conditions using primary care electronic health records

Rheumatology ◽  
2021 ◽  
Author(s):  
Dahai Yu ◽  
George Peat ◽  
Kelvin P Jordan ◽  
James Bailey ◽  
Daniel Prieto-Alhambra ◽  
...  
Keyword(s):  
Primary Care ◽  
Chronic Pain ◽  
Low Back Pain ◽  
Back Pain ◽  
Electronic Health Records ◽  
High Impact ◽  
Low Back ◽  
Musculoskeletal Health ◽  
Health Records ◽  
Electronic Health

Abstract Objectives Better indicators from affordable, sustainable data sources are needed to monitor population burden of musculoskeletal conditions. We propose five indicators of musculoskeletal health and assessed if routinely available primary care electronic health records (EHR) can estimate population levels in musculoskeletal consulters. Methods We collected validated patient-reported measures of pain experience, function and health status through a local survey of adults (≥35 years) presenting to English general practices over 12 months for low back pain, shoulder pain, osteoarthritis and other regional musculoskeletal disorders. Using EHR data we derived and validated models for estimating population levels of five self-reported indicators: prevalence of high impact chronic pain, overall musculoskeletal health (based on Musculoskeletal Health Questionnaire), quality of life (based on EuroQoL health utility measure), and prevalence of moderate-to-severe low back pain and moderate-to-severe shoulder pain. We applied models to a national EHR database (Clinical Practice Research Datalink) to obtain national estimates of each indicator for three successive years. Results The optimal models included recorded demographics, deprivation, consultation frequency, analgesic and antidepressant prescriptions, and multimorbidity. Applying models to national EHR, we estimated that 31.9% of adults (≥35 years) presenting with non-inflammatory musculoskeletal disorders in England in 2016/17 experienced high impact chronic pain. Estimated population health levels were worse in women, older aged and those in the most deprived neighbourhoods, and changed little over 3 years. Conclusion National and subnational estimates for a range of subjective indicators of non-inflammatory musculoskeletal health conditions can be obtained using information from routine electronic health records.

scholarly journals A mixed treatment comparison of selected osteopathic techniques used to treat acute nonspecific low back pain: a proof of concept and plan for further research

2021 ◽  
Vol 0 (0) ◽  
Author(s):  
James W. Price
Keyword(s):  
Low Back Pain ◽  
Back Pain ◽  
Spinal Manipulation ◽  
Conventional Care ◽  
Mixed Treatment Comparison ◽  
Low Back ◽  
Acute Low Back Pain ◽  
Treatment Comparison ◽  
Randomized Controlled ◽  
Mixed Treatment

Abstract Context Back injuries have a high prevalence in the United States and can be costly for both patients and the healthcare system at large. While previous guidelines from the American College of Physicians for the management of acute nonspecific low back pain (ANLBP) have encouraged nonpharmacologic management, those treatment recommendations involved only superficial heat, massage, acupuncture, and spinal manipulation. Investigation about the efficacy of spinal manipulation in the management of ANLBP is warranted. Objectives To compare the results in previously-published literature documenting the outcomes of osteopathic manipulative treatment (OMT) techniques used to treat ANLBP. The secondary objective of this study was to demonstrate the utility of using Bayesian network meta-analysis (NMA) to perform a mixed treatment comparison (MTC) of a variety of osteopathic techniques. Methods A literature search for randomized controlled trials (RCTs) of ANLBP treatments was performed in April 2020 according to PRISMA guidelines by searching MEDLINE/PubMed, OVID, Cochrane Central, PEDro, and OSTMED.Dr databases; scanning the reference lists of articles; and using the Canadian Agency for Drugs and Technologies in Health grey literature checklist. Each database was searched from inception to April 1, 2020. The following search terms were used: acute low back pain, acute low back pain plus physical therapy, acute low back pain plus spinal manipulation, and acute low back pain plus osteopathic manipulation. The validity of eligible trials was assessed by the single author using an adapted National Institute for Health and Care Excellence methodology checklist for randomized, controlled trials and an extraction form based on that checklist. The outcome measure chosen for this NMA was the Visual Analogue Scale of pain. The NMA were performed using the GeMTC user interface for automated NMA utilizing a Bayesian hierarchical model of random effects. Results The literature search initially found 483 unduplicated records. After screening and full text assessment, five RCTs were eligible for the MTC, yielding a total of 430 participants. Results of the MTC model suggested that there was no statistically significant decrease in reported pain when exercise, high-velocity low-amplitude (HVLA), counterstrain, muscle energy technique, or a mix of techniques were added to conventional treatment to treat ANLBP. However, the rank probabilities assessment determined that HVLA and the OMT mixed treatment protocol plus conventional care were ranked superior to conventional care alone for improving ANLBP. Conclusions While this study failed to provide definitive evidence upon which clinical recommendations can be based, it does demonstrate the utility of performing NMA for MTCs of osteopathic modalities used to treat ANLBP. However, to take full advantage of this statistical technique, future studies should be designed with consideration for the methodological shortcomings found in past osteopathic research.

scholarly journals An Observational Study Comparing Fibromyalgia and Chronic Low Back Pain in Somatosensory Sensitivity, Motor Function and Balance

Healthcare ◽  
2021 ◽  
Vol 9 (11) ◽  
pp. 1533
Author(s):  
José Antonio Mingorance ◽  
Pedro Montoya ◽  
José García Vivas Miranda ◽  
Inmaculada Riquelme
Keyword(s):  
Chronic Pain ◽  
Low Back Pain ◽  
Back Pain ◽  
Observational Study ◽  
Motor Function ◽  
Chronic Low Back Pain ◽  
Functional Performance ◽  
Low Back ◽  
Somatosensory Sensitivity ◽  
Chronic Pain Conditions

Fibromyalgia (FM) and chronic low back pain (CLBP) have shared pathophysiology and have a considerable impact on patients’ daily activities and quality of life. The main objective of this study was to compare pain impact, somatosensory sensitivity, motor functionality, and balance among 60 patients with FM, 60 patients with CLBP, and 60 pain-free controls aged between 30 and 65 years. It is essential to know the possible differences existing in symptomatology of two of the major chronic pain processes that most affect the population, such as FM and CLBP. The fact of establishing possible differences in sensory thresholds, motor function, and proprioceptive measures among patients with FM and CLBP could bring us closer to a greater knowledge of the chronic pain process. Through an observational study, a comparison was made between the three groups (FM, CLBP, and pain-free controls) evaluating functional performance, postural balance, kinematic gait parameters, strength, depression, fatigue, and sensitivity to pain and vibration. Patients with chronic pain showed worse somatosensory sensitivity (p < 0.001) and motor function (p < 0.001) than pain-free controls. Moreover, patients with FM showed greater pain impact (p < 0.001) and bigger somatosensory (p < 0.001) and motor deficiencies (p < 0.001) than patients with CLBP. Further research should explore the possible reasons for the greater deterioration in patients with FM in comparison with other chronic pain conditions. Our results, showing the multiple areas susceptible of deterioration, make it necessary to adopt interdisciplinary interventions focused both on physical and emotional dysfunction.

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