Research: ELKAYAM and colleagues, D

Listed in Issue 19

Abstract

ELKAYAM and colleagues, Department of Rheumatology, Tel Aviv Sourasky Medical Center, Ichilov Hospital, Tel Aviv University, Sackler Faculty of Medicine, Israel evaluated a multidisciplinary approach to patients with chronic back pain.

Background

Methodology

67 patients with back pain for more than 3 months participated in a comprehensive 4-week programme including back schooling, psychological intervention, acupuncture treatment, chiropractic, Alexander technique and a pain specialist. At admission to the study, patients completed a questionnaire about their socio-demographic background and disease history and also underwent a psychological evaluation based upon a questionnaire and an interview. Based upon this evaluation, patients were graded on three criteria: i) predominance of psychological factors; ii) secondary gain; iii) personality features. At treatment end, patients were divided into three groups according to their degree of improvement. Evaluation of patients occurred at the end of the 4-week programme and after 6 months.

Results

There was significant improvement to pain rating, pain frequency and pain-relief drug consumption in the treatment group, which was maintained for 6 months. Satisfactory outcome was correlated to a moderate predominance of psychological factors, good functioning, high degree of motivation and family support. Poor outcome was associated with divorced marital status and unemployment, diffuse complaints, post surgery status, a high predominance of psychological factors and presence of secondary gain and personality disorders.

Conclusion

Patients with chronic back pain appear to benefit from the multidisciplinary approach followed in this study. Improvement was maintained for 7 months and the outcome was clearly related to psychosocial factors.

References

Elkayam O et al. Multidisciplinary approach to chronic back pain: prognostic elements of the outcome. Clin Exp Rheumatol 14(3): 281-8. May-Jun 1996.

Comment

Considering the huge amount of misery caused by back pain, suffered by a majority of people at some time in their lives, the success of such a holistic, multi-disciplinary approach which includes psychological and social evaluation as well as physical treatment, makes one wonder why this approach is not the norm. Just as it is well known that bereavement and poor family and social support are poor prognostic factors for cancer and heart disease, it is not surprising that back pain may be refractory to improvement in people who are recovering from surgery, unemployed, without strong family support or stressed or depressed. It is hoped that increased publication of multi-disciplinary research such as the above may hasten the adoption and spread of such treatment approaches internationally.

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