Mindfulness Meditation for the Treatment of Chronic Low Back Pain: A Preliminary Quasi-randomized Controlled Pilot Study

Objective: To investigate the effectiveness of Mindfulness-Based Pain Therapy (MBPT) a treatment combining mindfulness meditation and several interventions taken from cognitive therapy within the frame of the multimodal pain therapy program, in patients suffering from chronic low back pain (CLBP).Design: A quasi-randomized case-control study. Subjects: The study included 20 subjects with chronic low back pain were recruited and quasi-randomly allocated to a standard multimodal pain therapy (n=10) or to a multimodal pain therapy group with MBPT (n=10). The intervention was identical for both groups except for the mindfulness meditation program.Methods. Both groups participated in a 4-week training, 5 times/week. All subjects underwent the same measurement protocol before and after the intervention. The program was evaluated on the basis of measure of pain, quality of life, disability, pain catastrophizing and depression. Results: The trial group displayed significant reduction in pain intensity, improvement in the quality of life, reduction in pain disability, in depression and pain catastrophizing. Conclusion: The study indicated that mindfulness meditation can influence the treatments and lead to a significant improvement in the overall result of the multimodal pain therapy.

Increase in Lower Limb Strength After Multimodal Pain Therapy in Patients With Low Back Pain

Study DesignProspective Study DesignObjectivesThe aim of the present study was to evaluate the efficacy of a multimodal pain therapy (MPM) regarding the objective parameter muscle strength of segment-dependent lower limb muscle groups before and after such a treatment. Methods52 patients with a history of low back pain and/or leg pain received standardized multimodal pain management. Strength of segment indicating lower limb muscles were assessed for each patient before and after ten days of treatment by handheld dynamometry. ResultsOverall strength increased significantly from 23.6kg ± 6.6 prior to treatment to 25.4 ± 7.3 after treatment, p≤0.001. All muscle groups significantly increased in strength with exception of great toe extensors. ConclusionDespite lower basic strength values at the beginning of treatment, all investigated muscle groups, with the exception of the great toe extensors, showed a significant increase of overall strength after completion of the multimodal pain management concept. Increased overall strength could help with avoiding further need of medical care by supporting patients’ autonomy in daily life activities, as well as maintaining working abilities. Thus, our study is the first to show a significant positive influence on lower limb strength in patients with low back pain after a conservative MPM program.

Impact of treatment dose on patient outcomes after Interdisciplinary Multimodal Pain Therapy

Objectives The impact of duration and intensity on outcomes after Interdisciplinary Multimodal Pain Therapy (IMPT) is poorly researched. The aim of this study was to compare the effects of low dose (LD, avg. 25 hours) and high dose IMPT (HD, avg. 110 hours).Methods Patients completed pain-related questionnaires at the beginning (T1), at the end of therapy (T2) and at 3-month follow-up (T3) and were matched according to age, sex, presence of back-pain and pain-related disability at T1, resulting in 32 patients per group. Primary endpoint was the difference in pain-related disability and average pain intensity at T3 between both groups. In addition, early treatment effects and group differences at T2 were analyzed.Results Both groups showed significant improvements in pain-related disability and average pain intensity between T1 and T2. These positive effects persisted in the HD group until the 3-month follow-up, whereas outcomes in the LD group patients deteriorated and were significantly poorer compared to HD at T3.Discussion Within a widely comparable therapeutic setting, high-dose IMPT was associated with longer lasting improvements compared to low-dose IMPT in chronic pain patients, indicating that the “dose” of therapy is a relevant factor for clinical outcomes and should be further investigated.

Erector Spinae Block for Chest Trauma in Aeromedical Prehospital and Retrieval Medicine

Pain management for patients with chest trauma in aeromedical prehospital and retrieval medicine is important in order to maintain respiratory function. However, it can be challenging to achieve with opioids alone due to side effects including sedation, respiratory depression, and nausea.Reported are two trauma patients with uncontrolled pain despite multiple doses of opioids managed with a single-injection erector spinae plane block (ESB).The sono-anatomy and performance of the block, indications, and possible complications associated with the ESB are described.An ultrasound-guided ESB is useful for multimodal pain therapy following chest trauma in aeromedical retrieval medicine.