Intensive interdisciplinary outpatient pain management program for chronic back pain: a pilot study

Figures & data

Table 1 Program inclusion criteria

Age over 18 years	Normal overall fitness
Pain duration > 12 weeks	Compliant with therapy
Prior standard treatment	Back pain*

Note:

* Nonspecific back pain, disc herniation without paresis, facet joint disease, spinal stenosis.

Table 2 Program exclusion criteria

Infection	Anticoagulation	Paresis
Severe instability	Myelopathy	Weak overall fitness
Pregnancy	Structural anomalies	Surgery during last 12 months
Severe osteoporosis	Somatoform disease	Red flags anamnesis
Age under 18 years	Substance abuse	Noncompliant with therapy
Fracture	Severe cardiopulmonary change

Table 3 Frequency of treatment modalities in our intensive interdisciplinary outpatient pain management program

Medical control	2× daily	Behavioral (relaxation) therapy	2× weekly
Exercise therapy	4× weekly (mean 12×)	Feldenkrais	2× weekly
Spinal injections	Mean 2–8× injections	Traction therapy	1–5× weekly
Back school	4× weekly	Electrotherapy	4–5× weekly
Equipment training (gym)	4× weekly	Fango	4–5× weekly
Sport therapy	4× weekly	Walking	1× weekly
Spa therapy*	4× weekly	Ergotherapy	1× weekly
Massage	4–5× weekly	Psychosomatic therapy	Variable

Note:

* Active training therapy in swimming pool.

Figure 1 and 2 Baseline to post-treatment improvement of pain and disability. Box plot legend: Upper whisker – Extends to the maximum data point; interquartile range box, middle 50% of the data; Top line – Q3 (third quartile). 75% of the data are less than or equal to this value. Middle line – Q2 (median); Target – mean value; Bottom line – Q1 (first quartile). 25% of the data are less than or equal to this value. Lower whisker – Extends to the minimum data point.

Table 4 Baseline and outcome characteristics

	Baseline, n (CI 95%)	Post-treatment, n (CI 95%)	Difference
Gender (n)
Male	70		–
Female	90		–
Age (years)	57.18 (22–82)		–
NRS (10-point scale)	6.03 (5.77–6.29)	2 (1.75–2.25)	4 (66.83%) P < 0.0001
ODI (%)	34.39 (31.93–36.85)	24.21 (21.82–26.6)	11 (33.33%) P < 0.0001

Abbreviations: CI, confidence interval; ODI, Oswestry Disability Index, NRS, Numeric Rating Scale.

Table 5 Sample comparison of efficacy of conservative therapies in chronic low back pain

Author	Description	Baseline NRS/ODI	Post-treatment NRS/ODI	Difference NRS/ODI
Descarreaux et al^Citation23	Individual home exercise program (n = 10, 6 weeks)	3.1/25.6	1.7/15.4	−45.2%/−39.8%
Mannion et al^Citation24	Comparative 3 groups (twice weekly, 12 weeks)
	Active physiotherapy	4.4/×	3.2/×	−27.3%/×
	Training devices	4.2/×	3.1/×	−26.2%/×
	Low-impact aerobics	4.1/×	3.4/×	−17.1%/×
Murtezani et al^Citation25	Comparative (2 groups, 12 weeks)
	High-intensity exercise	6.0/31	2.0/25.8	−66.7%/−49%
	Passive treatment (heat, TENS, ultrasound)	6.1/30.7	6.0/30.6	−1.64%/−0.33%
Brinkhaus et al^Citation26	Acupuncture (12×, 8 weeks)			−28.7%/×
Borman et al^Citation27	Physical therapy and traction (10×, 2 weeks)	5.7/32.3	3.8/26.8	−33.3%/−17.03%
Frost et al^Citation28	Fitness program with back school (6 months)	2.1/23.6	1.2/17.6	−28%/−25%
Van der Velde and Mierau^Citation29	Aerobic and flexibility exercise program (6 weeks)			−31%/−33%
Rydeard et al^Citation30	Pilates exercise (3× per week, 4 weeks)			−20.4%/×
Waagen et al^Citation31	Spinal manipulative treatments (2 weeks, reviews)		−0.5 to −1/×
Gibson et al^Citation32
Triano et al^Citation33
Assendelft et al^Citation34
Tsauo et al^Citation35	Functional training program (3 months)	11.8/22	5.6/16	−53.1%/−27.3%
Rainville et al^Citation36	Spine rehabilitation program (2–3× per week)			−28%/−25%
Sahin et al^Citation37	Back school program (n = 73, 2 weeks)	5.69/54.5	4.91/41.01	−13.7%/−24.8%
Luk et al^Citation38	Multidisciplinary rehabilitation program (n = 28, 14 weeks, follow-up 6 months)	3.8/42	22/29	−44%/−31%
Hazard et al^Citation39	Strength and endurance training, stretching, and behavioral support (n = 59, 3 weeks)			−26%/×
Edwards et al^Citation40	Resistive training, work hardening and manual treatment (n = 54, 4 weeks)			−30%/×

Abbreviations: ODI, Oswestry Disability Index, NRS, Numeric Rating Scale; TENS, transcutaneous electrical nerve stimulation.

DescarreauxMNormandMCLaurencelleLDugasCEvaluation of a specific home exercise program for low back painJ Manipulative Physiol Ther20022549750312381971

 PubMed Web of Science ®Google Scholar

MannionAFMüntenerMTaimetaSDvorakJComparison of three active therapies for chronic low back pain: results of a randomized clinical trial with one-year follow-upRheumatology20014077277811477282

 PubMed Web of Science ®Google Scholar

MurtezaniAHundoziHOrovcanecNSllamnikuSOsmaniTA comparison of high intensity aerobic exercise and passive modalities for the treatment of workers with chronic low back pain: a randomized, controlled trialEur J Phys Rehabil Med20114735936621602759

 PubMed Web of Science ®Google Scholar

BrinkhausBWittCMJenaSAcupuncture in patients with chronic low back painArch Intern Med200616645045716505266

 PubMedGoogle Scholar

BormanPKeskinDBodurHThe efficacy of lumbar traction in the management of patients with low back painRheumatol Int200323828612634941

 PubMed Web of Science ®Google Scholar

FrostHKlaber MoffetJAMoserJSFairbankJCTRandomised controlled trial for evaluation of fitness programme for patients with chronic low back painBr Med J19953101511547833752

 PubMed Web of Science ®Google Scholar

Van der VeldeGMierauDThe effect of exercise on percentile rank aerobic capacity, pain, and self-rated disability in patients with chronic low back pain: a retrospective chart reviewArch Phys Med Rehabil2000811457146311083348

 PubMed Web of Science ®Google Scholar

RydeardRLegerASmithDPilates-based therapeutic exercise: effect on subjects with nonspecific chronic low back pain and functional disability: a randomized controlled trialOrthop Sports Phys Ther200636472484

 PubMed Web of Science ®Google Scholar

WaagenGNHaldemanSCookGLopezDDeBoerKFShort-term trial of chiropractic adjustments for the relief of chronic low back painManual Med198626367

 Google Scholar

GibsonTGrahameRHarknessJWooPBlagravePHillsRControlled comparison of short-wave diathermy treatment with osteopathic treatment in nonspecific low back painLancet19851125812612860453

 PubMed Web of Science ®Google Scholar

TrianoJJMcGregorMHondrasMABrennanPCManipulative therapy versus education programs in chronic low back painSpine1995209489557644961

 PubMed Web of Science ®Google Scholar

AssendelftWJMortonSCYuEISuttorpMJShekellePGSpinal manipulative therapy for low-back painCochrane Database Syst Rev20041CD00044714973958

 PubMedGoogle Scholar

TsauoJYChenWHLiangHWJangYThe effectiveness of a functional training programme for patients with chronic low back pain – a pilot studyDisabil Rehabil2009311100110619802926

 PubMed Web of Science ®Google Scholar

RainvilleJJouveCAHartiganCMartinezEHiponaMComparison of short- and long-term outcomes for aggressive spine rehabilitation delivered two versus three times per weekSpine J2002240240714589260

 PubMedGoogle Scholar

SahinNAlbayrakIDurmusBUgurluHEffectiveness of back school for treatment of pain and functional disability in patients with chronic low back pain: a randomized controlled trialJ Rehabil Med20114322422921305238

 PubMed Web of Science ®Google Scholar

LukKDKWanTWMWongYWA multidisciplinary rehabilitation programme for patients with chronic low back pain: a prospective studyJ Orthop Surg201018131138

 Google Scholar

HazardRGFenwickJWKalischSMFunctional restoration with behavioral support: a one-year prospective study of patients with chronic low back painSpine1989141571612522243

 PubMed Web of Science ®Google Scholar

EdwardsBCZusmanMHardcastlePTwomeyLO’SullivanPMcLeanNA physical approach to the rehabilitation of patients disabled by chronic low back painMed J Aust19921561671711532045

 PubMed Web of Science ®Google Scholar