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Guideline Development Group meetings The GDG met at 5 to 6 weekly intervals for 16 months to review the evidence identified by the development team, to comment on its quality and relevance, and to develop recommendations for clinical practice based on the available evidence.
The recommendations were agreed by the full GDG. Care pathway A clinical care pathway see next page has been developed to indicate the key components in the treatment and management of non-specific LBP in adults. This is reproduced from the quick reference guide of the guideline, which is available at www.
Research recommendations What is the clinical and cost effectiveness of using screening protocols to target treatments for patients with non-specific low back pain?
Why this is important. People with poorer physical function and, in particular, those with psychological factors such as increased fear of activity, psychological distress, and negative feelings about back pain, are more disabled by their pain, and are more likely to have a poor outcome.
No UK study to date has demonstrated that targeting treatments based on a risk-factor profile leads to improved outcome or cost effectiveness. Research into matching people with low back pain to the specific treatments recommended is needed.
The role of both psychological and physical factors should be considered. This should include studies to identify which people are likely to gain the greatest benefit from treatments that are recommended in this guideline, and studies to identify which people are likely to benefit from treatments that are not currently recommended.
How can education be effectively delivered for people with chronic non-specific low back pain? Why this is important Improved understanding of low back pain and its management are identified as key components of care by both patients and healthcare professionals.
This guideline emphasises the importance of patient choice, which can only be exercised effectively if people have an adequate understanding of the available options. Extensive research literature addresses the education of adults using a wide variety of techniques, but studies of patient education for people with low back pain have focused almost exclusively on written information.
Little evidence is available as to whether such materials are the most effective way to deliver educational goals. Interdisciplinary projects combining educational and healthcare research methodologies should: What is the effectiveness and cost effectiveness of sequential interventions manual therapy, exercise and acupuncture compared with single interventions on pain, functional disability and psychological distress, in people with chronic non-specific back pain of between six weeks and one year?
There is evidence that manual therapy, exercise and acupuncture individually are cost-effective management options compared with usual care for persistent non-specific low back pain. The cost implications of treating people who do not respond to initial therapy and so receive multiple back care interventions are substantial.
It is unclear whether there is added health gain for this subgroup from either multiple or sequential use of therapies.
What is the effectiveness and cost effectiveness of psychological treatments for non-specific low back pain greater than six weeks?
Why this is important The effectiveness and cost effectiveness of psychological treatments for people with persistent non-specific low back pain is not known.
Data from randomised controlled trials studying people with a mixture of painful disorders, and other research, suggest that such treatments may be helpful for non-specific low back pain, but there are few robust data relating specifically to back pain.
If possible, the comparative effectiveness and cost effectiveness of different psychological treatments should be tested; for example, group compared with individual treatment, or treatment approaches based on different theories. What is the effectiveness and cost-effectiveness of facet-joint injections and radiofrequency lesioning for people with persistent non-specific low back pain?
Why this is important Many invasive procedures are performed on people with persistent non-specific low back pain. These are usually undertaken after the condition has lasted a long time more than 12 months.
Procedures such as facet joint injections and radiofrequency lesioning are performed regularly in specialist pain clinics. There is evidence that pain arising from the facet joints can be a cause of low back pain, but the role of specific therapeutic interventions remains unclear.
Case studies provide some evidence for the effectiveness of facet joint injections and medial branch blocks, but randomised controlled trials give conflicting evidence.Chronic low back pain (CLBP) is a major health issue in the western world and is a significant burden on health care; Americans spend $37 billion annually with a further $ billion lost in absenteeism .
Apr 24, · Tricyclic antidepressant use to mitigate chronic low back pain has been investigated by researchers as a form of treatment for decades.
Some articles go as far back as The types of antidepressants tested for efficacy in treatment of chronic low . Kevin Ameling, a chronic pain patient who now works for a Colorado-based non-profit cannabis research advocacy group called the IMPACT Network, is a success story.
Ameling believes cannabis saved. Recent research has revealed what many patients know all too well: chronic back pain is often accompanied by other types of pain, including headaches, other musculoskeletal disorders, temporomandibular joint disorders, fibromyalgia, irritable bowel syndrome and chronic fatigue syndrome.
Another reason for lower back pain is what is usually called lumbar strain. Basically, this term means lower back muscles, tendons, or ligaments have undergone a stretching injury, causing microscopic tears in these tissues (plombier-nemours.com).
Adapting to the changing situations created by the pain and adapting to the pain itself is very important in the management of chronic back pain.
Thus, psychological factors will acutely increase the pain (Maloney & McIntosh, ).It is an interconnected process which promotes mutually.