Does Disordered Sleep Moderate the Relationship Between Pain, Disability and Downstream Health Care Utilization in Patients With Low Back Pain?: A Longitudinal Cohort From the US Military Health System

Conclusion. Higher pain intensity and disability predicted higher pain-related HCU in the year following a LBP self-management class. The presence of a sleep disorder diagnosis, as recorded in medical records, had a significant independent effect on LBP-related health care visits and costs beyond the influences of pain intensity, disability, and other key demographic and health-related characteristics, but did not moderate these relationships. Level of Evidence: 3
Source: Spine - Category: Orthopaedics Tags: CLINICAL CASE SERIES Source Type: research

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Sickness absence mesmerizes many researchers, given the numerous publications on risk factors for sickness absence. A large variety of risk factors have been identified, including work-related risk factors such as physical work demands and psychosocial work factors (1,2), unhealthy behaviors such as lack pf physical activity and smoking (3,4), and chronic health problems (5). A logical next step seems to be the development of a prediction model, whereby an individual ’s profile on risk factors is converted into a probability on future sickness absence. In the past few years, several prediction models have been develo...
Source: Scandinavian Journal of Work, Environment and Health - Category: Occupational Health Tags: Editorial Source Type: research
Over the past few years I’ve been pondering the presumed gap between people living with pain and the people who “treat” or work with them.  Most of my readers will know that I live with widespread pain (aka fibromyalgia) or pain that is present in many parts of my body, and the associated other symptoms like DOMS that last for weeks not a day or two, and increased sensitivity to heat, cold, pressure, chilli, sound and so on. I first “came out” with my pain about 15 years ago: that is, I first disclosed to people I worked with that I had this weird ongoing pain – and finally joined...
Source: HealthSkills Weblog - Category: Anesthesiology Authors: Tags: Chronic pain Professional topics Research Therapeutic approaches inclusion inequality Source Type: blogs
Conclusions: This study revealed that stabilization exercise is very useful in the management of sleep disturbance, pain-related disability, depression, and anxiety in NSCLBP patients. PMID: 30013734 [PubMed]
Source: Korean Journal of Pain - Category: Anesthesiology Tags: Korean J Pain Source Type: research
CONCLUSIONS: A combination of rehabilitation and mattress overlay use seems an effective approach for improvement of pain, perceived back disability, sleep, spine mobility, and lumbar multifidus size and structure of LBP patients. PMID: 29991121 [PubMed - as supplied by publisher]
Source: Journal of Back and Musculoskeletal Rehabilitation - Category: Orthopaedics Tags: J Back Musculoskelet Rehabil Source Type: research
I could write about a BPS (biopsychosocial) model in every single post, but it’s time for me to explore other things happening in the pain management world, so this is my last post in this series for a while. But it’s a doozy! And thanks to Eric Bowman for sharing an incredibly relevant paper just in time for this post… One of the problems in pain management is that there are so many assessments carried out by the professionals seeing a person – but very little discussed about pulling this information together to create an overall picture of the person we’re seeing. And it’s this aspect...
Source: HealthSkills Weblog - Category: Anesthesiology Authors: Tags: Assessment Back pain Clinical reasoning Low back pain Pain conditions Professional topics Research Science in practice biopsychosocial disability function Health healthcare pain management rehabilitation Therapeutic approache Source Type: blogs
And yes! There’s more to this series of posts on how I use a biopsychosocial model in practice! Today’s post is about moving from a conceptual model to a practical model, or how we can use research in our clinical reasoning. A biopsychosocial model (BPSM) as envisaged by Engel was a framework for clinicians to think about why this person is presenting in this way at this time (and what may be maintaining their situation), as well as what could be done to reduce distress and disability. Engel wanted clinicians to go beyond disease processes, isolated from the people experiencing them, and to explore aspects of h...
Source: HealthSkills Weblog - Category: Anesthesiology Authors: Tags: Chronic pain Clinical reasoning Coping strategies Pain conditions Professional topics Research biopsychosocial disability function Health healthcare Low back pain pain management Therapeutic approaches Source Type: blogs
Authors: Nijs J, Clark J, Malfliet A, Ickmans K, Voogt L, Don S, den Bandt H, Goubert D, Kregel J, Coppieters I, Dankaerts W Abstract Conservative, surgical and pharmacological strategies for chronic low back pain (CLBP) management offer at best modest effect sizes in reducing pain and related disability, indicating a need for improvement. Such improvement may be derived from applying contemporary pain neuroscience to the management of CLBP. Current interventions for people with CLBP are often based entirely on a "biomedical" or "psychological" model without consideration of information concerni...
Source: Clinical and Experimental Rheumatology - Category: Rheumatology Tags: Clin Exp Rheumatol Source Type: research
This study provides some support for using single item questions to identify those who need more in-depth assessment, and those who don’t need this level of attention. I like that! The idea that we can triage those who probably don’t need the whole toolbox hurled at them is a great idea. Perhaps the New Zealand politicians, as they begin the downhill towards general elections at the end of the year, could be asked to thoughtfully consider rational distribution of healthcare, and a greater emphasis on targeted use of allied health and expensive surgery.   Deyo, R. A., &Mirza, S. K. (2016). Herniated Lum...
Source: HealthSkills Weblog - Category: Anesthesiology Authors: Tags: Assessment Back pain Chronic pain Coping strategies Interdisciplinary teams News Pain conditions Professional topics Research biopsychosocial disability healthcare rehabilitation self management treatment Source Type: blogs
The Pain Catastrophising Scale is one of the more popular measures used in pain assessment. It’s popular because catastrophising (thinking the worst) has been identified as an especially important risk factor for slow recovery from pain (Abbott, Tyni-Lenne &Hedlund, 2010), for reporting high levels of pain intensity (Langley, 2011), and for ongoing disability (Elfving, Andersoon &Grooten, 2007). I could have cited hundreds more references to support these claims, BTW. The problem is, once the PCS is administered and scored: what then? What difference does it make in how we go about helping a person think a li...
Source: HealthSkills Weblog - Category: Anesthesiology Authors: Tags: Assessment Back pain Clinical reasoning Coping Skills Coping strategies Education Low back pain Pain conditions biopsychosocial Chronic pain Occupational therapy pain management rehabilitation Therapeutic approaches Source Type: blogs
In the excitement of helping people understand more about pain neuroscience, which I truly do support, I think it’s useful to reflect a little on the history of this approach, and how it can influence the experience people have of their pain. If we go right back to the origins of pain self management, in the groovy 1960’s and 1970’s – the first truly significant work in chronic pain self management came from Wilbert Fordyce (Fordyce, Fowler &Delateur, 1968). Bill Fordyce was a clinical psychologist working in the Department of Physical Medicine and Rehabilitation, University of Washington, Seatt...
Source: HealthSkills Weblog - Category: Anesthesiology Authors: Tags: Chronic pain Clinical reasoning Education/CME Pain conditions Science in practice acceptance biopsychosocial healthcare pain management Research Therapeutic approaches Source Type: blogs
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