Elsevier

Disease-a-Month

Volume 62, Issue 9, September 2016, Pages 330-333
Disease-a-Month

Chronic low back pain

https://doi.org/10.1016/j.disamonth.2016.05.012Get rights and content

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Epidemiology

Due to varied clinical diagnoses of chronic low back pain (CLBP) in previous literature, findings about epidemiological features of CLBP are inconsistent. However, there is a wide range of prevalence of CLBP recorded thus far. Rising prevalence of chronic low back pain is attributed to the increased disability rates and healthcare costs.1 Individuals who are at risk for low back pain (LBP) are those who are over the age of 30 years, obese or have a high body mass index (BMI) (BMI > 30 kg/m2),

Pathophysiology

While nociception refers to physiological detection of noxious stimuli, pain is a psychological term, involving unpleasant sensory and emotional experience. Understanding the pathophysiology of pain perception is essential for effective treatment. The perception of pain starts with peripheral sensory neurons or nociceptors that get activated by noxious stimuli via free nerve endings in the skin and deeper tissues.6

These specialized nerve fibers transmit information using glutamate

Treatment strategies

The definition of chronic low back pain can vary depending on the resource. Generally it is accepted to mean low back pain that has been present for 3–6 months despite medical intervention. The standard medical intervention for the low back pain sufferer can also be debated. For the purposes of this review, it would come to mean failed pharmacopeia, rehabilitation, injection therapy, and perhaps even surgery. While it is beyond the scope of this article to cover all these treatment measures,

Multidisciplinary approach

Multidisciplinary (also sometimes referred to as biopsychosocial model) rehabilitation is an approach designed to address this population of patient with CLBP refractory to standard measures. The team of healthcare providers involved in such a program typically includes physical therapists, vocational therapists, social workers, and psychologists. There is a usually a lead physician specializing in pain management orchestrating care. This person may be called upon for injection therapy, for

Conclusions

Measuring success of such programs is a daunting task. Various studies use different metrics such as decreased pain and/or disability. Also, not all programs are identical in their approach. Finally you have the heterogeneity of that patient population. However, it is generally concluded that programs such as these tend to be an effective means of lowering pain and disability when compared to a fragmented approach.17, 18 As with most complex medical conditions, more attention to standardizing

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References (18)

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    FRP include selective exercises involving muscle strengthening, muscle stretching, control of trunk muscles, and aerobic exercises.3 These programs tend to emphasize “well behaviors” and prevent “sick behaviors”, without specific motor control exercises.4 A biopsychosocial approach is encouraged and focused on improvement in accordance with the profession and the return to work.4

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    Chronic low back pain (CLBP) is a highly prevalent incapacitating condition in developed countries, causing a great socioeconomic burden on healthcare systems worldwide (Meucci et al., 2015; Shmagel et al., 2016). While most low back pain episodes are brief, 5–10% of patients experience prolonged episodes exceeding three months, referred to as CLBP (Alleva et al., 2016). CLBP is associated with a reduced health-related quality of life (HRQoL) due to the accompanying psychosocial stress, pain, and impairment to vitality and functional status (Dueñas et al., 2016; Husky et al., 2018).

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