scholarly journals Practical guidelines for the treatment of chronic nonspecific low back pain and comorbid chronic insomnia: clinical observation

2021 ◽  
pp. 164-170
Author(s):  
V. A. Golovacheva ◽  
A. A. Golovacheva ◽  
V. L. Golubev
Keyword(s):  
Low Back Pain ◽  
Back Pain ◽  
Clinical Case ◽  
Pain Catastrophizing ◽  
Behavioral Therapy ◽  
Chronic Insomnia ◽  
Low Back ◽  
Modern Approach ◽  
Days Of Therapy ◽  
Yellow Flags

A clinical case of a patient with chronic nonspecific low back pain and comorbid chronic insomnia is described, and a modern approach to the management of this patient category is shown. So-called yellow flags - factors that contribute to the central sensitization of pain - lead to chronicity of LBP. In the presented clinical case we identified the most common "yellow flags”: insomnia, pain catastrophizing, restrictive ”pain” behavior, anxiety. In practice, they often ignore the aforementioned factors, determine only the presence of back pain and prescribe analgesic therapy, which does not allow for an effective result.Insomnia is prevalent among patients with LBP, occurring in 47-64% of cases. With the COVID-19 pandemic among the population, the incidence of insomnia, anxiety and depression has increased. To date, the identification and treatment of these disorders is particularly relevant in the management of patients with chronic nonspecific LBP.The patient was treated, which included non-drug and drug methods and complied with Russian and foreign clinical guidelines on the therapy of chronic nonspecific LBP and on the therapy of chronic insomnia. Non-drug treatment consisted of educational talks, recommendations on daily activity and sleep hygiene, cognitive-behavioral therapy, mindfulness, relaxation, and therapeutic gymnastics. The listed methods were aimed at reducing pain catastrophizing, physical and social activation of the patient. The nonsteroidal anti-inflammatory drug dexketoprofen was used as pharmacotherapy according to a step-by-step regimen. After 5 days of therapy pain relief was observed, after 3 months of therapy back pain regressed, sleep normalized, mood improved. This therapeutic approach showed its effectiveness and safety in the treatment of chronic nonspecific LBP and comorbid chronic insomnia.

scholarly journals Rumination-Focused Cognitive-Behavioral Therapy for Chronic Low Back Pain: A Randomized Controlled Trial

2020 ◽  
Vol 9 ◽  
Author(s):  
Ali Soleymani ◽  
Abbas Masjedi Arani ◽  
Seyed Ahmad Raeissadat ◽  
Mohammad Hassan Davazdahemami
Keyword(s):  
Chronic Pain ◽  
Randomized Controlled Trial ◽  
Low Back Pain ◽  
Back Pain ◽  
Chronic Low Back Pain ◽  
Pain Catastrophizing ◽  
Behavioral Therapy ◽  
Controlled Trial ◽  
Low Back ◽  
Randomized Controlled

Background: Chronic pain remains or reappears for more than 3 to 6 months, and it is influencing 20% of the global population. The pain catastrophizing affects pain intensity and psychological conditions of patients with chronic pain. Rumination-focused cognitive-behavioral therapy (RFCBT) targets rumination as the key component of pain catastrophizing. The aim of this study was to determine the effectiveness of RFCBT on depression, anxiety, and pain severity of individuals with chronic low back pain (LBP). Materials and Methods: In a randomized controlled trial, 30 patients aged between 20-55 years with diagnosed chronic LBP were chosen by convenience sampling and randomly allocated into intervention and control groups. All patients used their prescribed medications for pain management, but the intervention group received 12 weekly sessions of RFCBT, which was manualized psychotherapy to change unconstructive rumination to constructive rumination. Depression Anxiety and Stress scale-21 and chronic pain grade questionnaire were administered as pre-tests and re-administered after 3 and 6 months as post-test and follow-up assessments, respectively. Results: RFCBT significantly reduced depression (F1=23.01, P=0.001), anxiety (F1=25.7, P=0.001) and pain severity (F1=7.17, P=0.012) in patients with chronic LBP. Conclusion: RFCBT may offer benefits for treating patients with chronic low back pain when added to their usual pharmacological treatment. This benefit may be the result of targeting rumination as the key element of pain catastrophizing. [GMJ.2020;9:e1722]

scholarly journals Psychological methods in the treatment of chronic nonspecific low back pain

2019 ◽  
Vol 11 (2S) ◽  
pp. 25-32 ◽  
Author(s):  
V. A. Golovacheva ◽  
A. A. Golovacheva ◽  
T. G. Fateeva
Keyword(s):  
Low Back Pain ◽  
Back Pain ◽  
Pain Catastrophizing ◽  
Behavioral Therapy ◽  
Adult Population ◽  
Interdisciplinary Approach ◽  
Disease Recurrence ◽  
Interdisciplinary Treatment ◽  
Low Back ◽  
Therapeutic Exercises

Among the adult population, every two persons have experienced at least an episode of back pain during their lifetime. Nonspecific (musculoskeletal) low back pain (LBP) becomes chronic in 3–10% of people. These cases require combined interdisciplinary treatment, including optimal pharmacotherapy, rational physical activity, therapeutic exercises, psychological methods, an educational program (back pain school for patients); some cases need manual therapy, massage. Psychological methods assist patients to cope with pain catastrophizing, to increase daily activity, and to reduce the likelihood of disease recurrence. The results of clinical trials and systematic reviews demonstrate that cognitive behavioral therapy and mindfulness therapy (mindfulness-based stress reduction) are effective in treating chronic LBP. The paper describes a clinical case: an example of effective treatment of a female patient with chronic nonspecific LBP, by applying an integral interdisciplinary approach.

scholarly journals Hypervigilance for bodily sensations in the back during a movement task in people with chronic and recurrent low back pain

2019 ◽  
Author(s):  
Amanda Clauwaert ◽  
Stijn Schouppe ◽  
Jessica Van Oosterwijck ◽  
Lieven Danneels ◽  
Stefaan Van Damme
Keyword(s):  
Low Back Pain ◽  
Back Pain ◽  
Pain Catastrophizing ◽  
Event Related Potentials ◽  
Neutral Condition ◽  
Low Back ◽  
Related Potentials ◽  
Bodily Sensations ◽  
Somatosensory Stimuli ◽  
Recurrent Low Back Pain

Objectives. The current study assessed the role of hypervigilance for bodily sensations in the back in long term low back pain (LBP) problems. Methods. People with chronic low back pain (CLBP), recurrent low back pain (RLBP), and no LBP were compared on the extent to which they attended to somatosensory stimuli on the back during a movement task. To measure hypervigilance, somatosensory event-related potentials (SEP) to task-irrelevant tactile stimuli on the back were measured when preparing movements in either a threatening or a neutral condition, indicated by a cue signaling possible pain on the back during movement or not. Results. Results showed stronger attending to stimuli on the back in the threat condition than in the neutral condition, as reflected by increased amplitude of the N96 SEP. However, this effect did not differ between groups. The CLBP group showed a larger P171 SEP than the other groups, but this effect was not dependent upon condition, suggesting a more general state of arousal resulting in increased somatosensory responsiveness. No significant associations were found between somatosensory attending to the back and theorized antecedents such as pain catastrophizing, pain-related fear and pain vigilance. Discussion. The current study confirmed that individuals preparing a movement attended more towards somatosensory stimuli at the lower back when anticipating back pain during the movement, as measured by the N96 SEP. However, no differences were found for this component between participants suffering from CLBP or RLBP, or the healthy controls.

Changes in Pain Catastrophizing and Fear-Avoidance Beliefs as Mediators of Early Physical Therapy on Disability and Pain in Acute Low-Back Pain: A Secondary Analysis of a Clinical Trial

Pain Medicine ◽  
2021 ◽  
Author(s):  
Brittany L Sisco-Taylor ◽  
John S Magel ◽  
Molly McFadden ◽  
Tom Greene ◽  
Jincheng Shen ◽  
...  
Keyword(s):  
Clinical Trial ◽  
Low Back Pain ◽  
Back Pain ◽  
Physical Therapy ◽  
Pain Catastrophizing ◽  
Low Back ◽  
Fear Avoidance ◽  
Fear Avoidance Beliefs ◽  
Acute Low Back Pain ◽  
Early Physical Therapy

Abstract Objective The Fear-Avoidance Model of chronic pain (FAM) posits that pain catastrophizing and fear-avoidance beliefs are prognostic for disability and chronicity. In acute low-back pain, early physical therapy (PT) is effective in reducing disability in some patients. How early PT impacts short- and long-term changes in disability for patients with acute pain is unknown. Based on the FAM, we hypothesized that early reductions in pain catastrophizing and fear-avoidance beliefs would mediate early PT’s effect on changes in disability (primary outcome) and pain intensity (secondary outcome) over 3 months and 1 year. Subjects Participants were 204 patients with low-back pain of < 16 days duration, who enrolled in a clinical trial (NCT01726803) comparing early PT sessions or usual care provided over 4 weeks. Methods Patients completed the Pain Catastrophizing Scale (PCS), Fear-Avoidance Beliefs Questionnaire (FABQ work and physical activity scales) and outcomes (Oswestry Disability Index and Numeric Pain Rating Scale) at baseline, 4 weeks, 3 months, and 1 year. We applied longitudinal mediation analysis with single and multiple mediators. Results Early PT led to improvements in disability and pain over 3 months, but not 1 year. In the single mediator model, four-week reductions in pain catastrophizing mediated early PT’s effects on 3-month disability and pain intensity improvements, explaining 16% and 22% of the association, respectively, but the effects were small. Pain catastrophizing and fear-avoidance beliefs did not jointly mediate these associations. Conclusions In acute low-back pain, early PT may improve disability and pain outcomes at least partly through reducing patients’ catastrophizing.

Associations between the severity of disability level and fear of movement and pain beliefs in patients with chronic low back pain

2020 ◽  
Vol 33 (5) ◽  
pp. 785-791 ◽  
Author(s):  
Nuray Alaca ◽  
Hande Kaba ◽  
Ayce Atalay
Keyword(s):  
Low Back Pain ◽  
Back Pain ◽  
Chronic Low Back Pain ◽  
Behavioral Therapy ◽  
Short Form ◽  
Low Back ◽  
Pain Beliefs ◽  
Fear Of Movement ◽  
Severity Of Disability ◽  
The Impact

BACKGROUND AND OBJECTIVES: Low back pain (LBP) is one of the leading forms of chronic pain and is among the leading causes of pain and disability. In this study, we investigated the associations between the severity of disability and fear of movement and pain beliefs as well as the impact of the fear of movement and pain beliefs on the quality of life in patients with chronic LBP. METHODS: A total of 89 patients (42.29 ± 16.05 years) with chronic low back pain were included in the study. The instruments used in the assessments include the Visual Analogue Scale (VAS), the Oswestry Disability Index (ODI), the Tampa Kinesiophobia Scale (TKS), the Pain Belief Questionnaire (PBQ), and the SF 36-Short Form. Patients were assigned into three groups by disability severity based on ODI scores. Statistical analysis was performed using SPSS 15. RESULTS: No statistically significant intergroup differences were found in TKS and PBQ scores (p> 0.05). A positive correlation was found between TKS scores, age (r: 0.227/p< 0.05), PBQ organic (r: -0.250/p< 0.05) scores. CONCLUSIONS: Our study revealed high levels of kinesiophobia and similar pain beliefs, independent of the severity level of disability. We believe that cognitive-behavioral therapy that may reduce fear-avoidance behaviors and convert negative pain beliefs into positive ones should be added to rehabilitation procedures for LBP.

scholarly journals Comparative Associations of Working Memory and Pain Catastrophizing With Chronic Low Back Pain Intensity

2016 ◽  
Vol 96 (7) ◽  
pp. 1049-1056 ◽  
Author(s):  
Corey B. Simon ◽  
Trevor A. Lentz ◽  
Mark D. Bishop ◽  
Joseph L. Riley ◽  
Roger B. Fillingim ◽  
...  
Keyword(s):  
Working Memory ◽  
Low Back Pain ◽  
Back Pain ◽  
Pain Intensity ◽  
Chronic Low Back Pain ◽  
Pain Catastrophizing ◽  
Future Research ◽  
Low Back ◽  
Cross Sectional ◽  
Daily Pain

Abstract Background Because of its high global burden, determining biopsychosocial influences of chronic low back pain (CLBP) is a research priority. Psychological factors such as pain catastrophizing are well established. However, cognitive factors such as working memory warrant further investigation to be clinically useful. Objective The purpose of this study was to determine how working memory and pain catastrophizing are associated with CLBP measures of daily pain intensity and movement-evoked pain intensity. Design This study was a cross-sectional analysis of individuals with ≥3 months of CLBP (n=60) compared with pain-free controls (n=30). Method Participants completed measures of working memory, pain catastrophizing, and daily pain intensity. Movement-evoked pain intensity was assessed using the Back Performance Scale. Outcome measures were compared between individuals with CLBP and those who were pain-free using nonparametric testing. Associations were determined using multivariate regression analyses. Results Participants with CLBP (mean age=47.7 years, 68% female) had lower working memory performance (P=.008) and higher pain catastrophizing (P&lt;.001) compared with pain-free controls (mean age=47.6 years, 63% female). For individuals with CLBP, only working memory remained associated with daily pain intensity (R2=.07, standardized beta=−.308, P=.041) and movement-evoked pain intensity (R2=.14, standardized beta=−.502, P=.001) after accounting for age, sex, education, and interactions between pain catastrophizing and working memory. Limitations The cross-sectional design prevented prospective analysis. Findings also are not indicative of overall working memory (eg, spatial) or cognitive performance. Conclusion Working memory demonstrated the strongest association with daily pain and movement-evoked pain intensity compared with (and after accounting for) established CLBP factors. Future research will elucidate the prognostic value of working memory on prevention and recovery of CLBP.

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