Psychological risk and protective factors for disability in chronic low back pain – a longitudinal analysis in primary care

AbstractBackground and aimsBased on a transdiagnostic approach, this study assesses the impact of cognitive and emotional processes (difficulties in emotional regulation, impulsiveness, rumination and somatosensory amplification) on the psychological risk factors of chronic low-back pain.MethodsThe study was carried out with 256 patients with chronic low-back pain. All the variables were assessed through a booklet of 10 validated questionnaires. Multiple regression analysis and moderation analysis were performed.ResultsPredictors included in multiple regression models explain 3%-42% (adjusted R2) of the variance in psychological risk factors. Moreover, analyses reveal a significant moderator effect of somatosensory amplification on the link between fear-avoidance beliefs linked to work and pain intensity (F(3;250) = 12.33; p = .00), of somatosensory amplification and brooding on the link between depression and functional repercussions (FR) on everyday life (F(3;252) = 13.36; p = .000; F(1;252) = 12.42; p = .00), of the reflection dimension of rumination on the link between the helplessness dimension of catastrophizing and FRs on sociability (F(3;252) = 37.02; p = .00). There is also a moderation analysis with a significant trend concerning the lack of emotional awareness and the difficulties in controlling impulsive behaviours.ConclusionsOur results indicate an important role of some dimensions of difficulties in emotional regulation, somatosensory amplification and rumination in the increase in negative affects and dysfunctional beliefs, and in the links between those psychological risk factors and pain/disability.ImplicationsThis study identifies some cognitive and emotional dysregulations substantially involved in work-related chronic pain. This contribute to put in place psychotherapeutic protocols to tackle these deficits and dysregulations in a relevant way.

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A Pain eHealth Platform for Engaging Obese, Older Adults with Chronic Low Back Pain in Nonpharmacological Pain Treatments: Protocol for a Pilot Feasibility Study

JMIR Research Protocols ◽

10.2196/14525 ◽

2020 ◽

Vol 9 (1) ◽

pp. e14525

Author(s):

Amber K Brooks ◽

David P Miller Jr ◽

Jason T Fanning ◽

Erin L Suftin ◽

M Carrington Reid ◽

...

Keyword(s):

Older Adults ◽

Primary Care ◽

Low Back Pain ◽

Back Pain ◽

Chronic Low Back Pain ◽

Primary Care Providers ◽

Patient Portal ◽

Low Back ◽

Care Providers ◽

Web Based

Background Low back pain is a costly healthcare problem and the leading cause of disability among adults in the United States. Primary care providers urgently need effective ways to deliver evidence-based, nonpharmacological therapies for chronic low back pain. Guidelines published by several government and national organizations have recommended nonpharmacological and nonopioid pharmacological therapies for low back pain. Objective The Pain eHealth Platform (PEP) pilot trial aims to test the feasibility of a highly innovative intervention that (1) uses an electronic health record (EHR) query to systematically identify a phenotype of obese, older adults with chronic low back pain who may benefit from Web-based behavioral treatments; (2) delivers highly tailored messages to eligible older adults with chronic low back pain via the patient portal; (3) links affected patients to a Web app that provides education on the efficacy of evidence-based, nonpharmacological, behavioral pain treatments; and (4) directs patients to existing Web-based health treatment tools. Methods Using a three-step modified Delphi method, an expert panel of primary care providers will define a low back pain phenotype for an EHR query. Using the defined low back pain phenotype, an EHR query will be created to identify patients who may benefit from the PEP. Up to 15 patients with low back pain will be interviewed to refine the tailored messaging, esthetics, and content of the patient-facing Web app within the PEP. Up to 10 primary care providers will be interviewed to better understand the facilitators and barriers to implementing the PEP, given their clinic workflow. We will assess the feasibility of the PEP in a single-arm pragmatic pilot study in which secure patient portal invitations containing a hyperlink to the PEP Web app are sent to 1000 patients. The primary outcome of the study is usability as measured by the System Usability Scale. Results Qualitative interviews with primary care providers were completed in April 2019. Qualitative interviews with patients will begin in December 2019. Conclusions The PEP will leverage informatics and the patient portal to deliver evidence-based nonpharmacological treatment information to adults with chronic low back pain. Results from this study may help inform the development of Web-based health platforms for other pain and chronic health conditions. International Registered Report Identifier (IRRID) DERR1-10.2196/14525

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A Pain eHealth Platform for Engaging Obese, Older Adults with Chronic Low Back Pain in Nonpharmacological Pain Treatments: Protocol for a Pilot Feasibility Study (Preprint)

10.2196/preprints.14525 ◽

2019 ◽

Author(s):

Amber K Brooks ◽

David P Miller Jr ◽

Jason T Fanning ◽

Erin L Suftin ◽

M Carrington Reid ◽

...

Keyword(s):

Older Adults ◽

Primary Care ◽

Low Back Pain ◽

Back Pain ◽

Chronic Low Back Pain ◽

Primary Care Providers ◽

Patient Portal ◽

Low Back ◽

Care Providers ◽

Web Based

BACKGROUND Low back pain is a costly healthcare problem and the leading cause of disability among adults in the United States. Primary care providers urgently need effective ways to deliver evidence-based, nonpharmacological therapies for chronic low back pain. Guidelines published by several government and national organizations have recommended nonpharmacological and nonopioid pharmacological therapies for low back pain. OBJECTIVE The Pain eHealth Platform (PEP) pilot trial aims to test the feasibility of a highly innovative intervention that (1) uses an electronic health record (EHR) query to systematically identify a phenotype of obese, older adults with chronic low back pain who may benefit from Web-based behavioral treatments; (2) delivers highly tailored messages to eligible older adults with chronic low back pain via the patient portal; (3) links affected patients to a Web app that provides education on the efficacy of evidence-based, nonpharmacological, behavioral pain treatments; and (4) directs patients to existing Web-based health treatment tools. METHODS Using a three-step modified Delphi method, an expert panel of primary care providers will define a low back pain phenotype for an EHR query. Using the defined low back pain phenotype, an EHR query will be created to identify patients who may benefit from the PEP. Up to 15 patients with low back pain will be interviewed to refine the tailored messaging, esthetics, and content of the patient-facing Web app within the PEP. Up to 10 primary care providers will be interviewed to better understand the facilitators and barriers to implementing the PEP, given their clinic workflow. We will assess the feasibility of the PEP in a single-arm pragmatic pilot study in which secure patient portal invitations containing a hyperlink to the PEP Web app are sent to 1000 patients. The primary outcome of the study is usability as measured by the System Usability Scale. RESULTS Qualitative interviews with primary care providers were completed in April 2019. Qualitative interviews with patients will begin in December 2019. CONCLUSIONS The PEP will leverage informatics and the patient portal to deliver evidence-based nonpharmacological treatment information to adults with chronic low back pain. Results from this study may help inform the development of Web-based health platforms for other pain and chronic health conditions. INTERNATIONAL REGISTERED REPORT DERR1-10.2196/14525

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