New Research on Back Pain and Stress

Keele University in Staffordshire, England is fifty years old and educates 10,000 undergraduates on a square mile of land once owned by the same family for four centuries and prior to that by the medieval Knights Templar.  Their arthritis research unit has published an interesting paper comparing usual care of low back pain with a new approach based on stratifying patients into three groups (1).

They begin by pointing out that 6-9% of adults in the UK see their GP about back pain annually and only about 1/3 are free of pain or disability a year later.  It is clear these patients are not homogeneous, but not clear what treatment is best for each individual.  Consequently the authors administered a previously validated 9-item questionnaire to stratify back pain patients into those with low, medium or high risk for persistent disability.  Interestingly, high risk for disability is predicted by positive answers to at least four of the five items on the psychosocial sub-scale of the questionnaire and 28% fell into this group.

The patients were randomly chosen either to be in a control group who received usual care, or in a study group where treatment was tailored to their disability risk.  All in the study group received an assessment and educational information, those at medium risk also received referral to a physical therapist (PT) and those at high risk received referral for “psychologically informed” physical therapy.

The primary outcome of this research was the score on a questionnaire measuring disability.  In the low risk group, even though about 1/2 the control subjects were referred for physical therapy compared to almost none  in the study group, there was no difference in outcome.  For those at medium risk, about 1/3 in the control group were not referred for physical therapy compared to nearly all in the study group and the latter had a better outcome at 4 and 12 months later.  In the group at high risk for disability, again about 1/3 in the control group were not referred for PT compared to nearly all in the study group, but here although there was a better outcome in the study group at 4 months, this improvement was lost at 12 months.  Taken as a whole, the study group also had better outcomes for fear, depression and tendency to catastrophize their situation.  In addition, health care costs and days off work were lower for the study group while treatment satisfaction was higher.

This research documents a significant benefit in outcomes, costs and satisfaction with treatment in patients with back pain when psychological factors are assessed and used to guide treatment.  I strongly suspect that if psychological factors had been assessed in more detail and treated by mental health professionals rather than physical therapists that the long term outcome in the high risk group would have been substantially better.  Nevertheless, this paper is an important step in bringing care of back pain into the 21st century.

1. Hill JC et all.  Comparison of stratified primary care management for low back pain with current best practice (StarT Back): a randomized controlled trial.  Lancet Oct 2011; p 1560 – 1571.

Tags: ,

621 Responses to “New Research on Back Pain and Stress”

  1. I was curious if you ever thought of changing the layout
    of your blog? Its very well written; I love what youve got to say.
    But maybe you could a little more in the way of content so people could connect with it better.
    Youve got an awful lot of text for only having 1 or two images.

    Maybe you could space it out better?

    Also visit my web blog … flick pest control

  2. I always spent my half an hour to read this website’s content everyday along with a mug of coffee.

  3. If you are going for best contents like me, simply visit this web page every day since it provides feature contents,

    Feel free to surf to my web site Nintendo 3ds emulator download

  4. Hellen says:

    Hello! I know this is kind of off-topic however
    I had to ask. Does managing a well-established website such as yours require a lot of work?

    I’m completely new to running a blog but I do write in my diary daily.
    I’d like to start a blog so I can easily share my own experience and views
    online. Please let me know if you have any kind of ideas or tips for brand new
    aspiring bloggers. Thankyou!

    Also visit my page: nintendo 3ds emulator download – Hellen -

  5. Both forms of trafficking in chicago debt consolidation consolidating
    the various debts of the student. The construction and industrial sectors were badly affected
    by the amount of funds are known to be designed
    around the budget of the debtor. It may in fact only take months
    to regain control over your finances and only a lump
    sum payment to be made then they can make on your name.

    Here is my page;

  6. bmi chart says:

    Just wish to say your article is as amazing. The clarity in your
    post is just spectacular and i could assume you’re an expert on this subject.
    Well with your permission allow me to grab your RSS feed to keep up to
    date with forthcoming post. Thanks a million and please keep up the
    gratifying work.

    Also visit my web-site – bmi chart

  7. Wow, amazing blog layout! How long have you been blogging for?
    you made blogging look easy. The overall look of your website is wonderful, as
    well as the content!

  8. Hmm it seems like your site ate my first comment (it was super long) so I
    guess I’ll just sum it up what I submitted and say, I’m thoroughly enjoying your
    blog. I too am an aspiring blog blogger but I’m still new to everything.
    Do you have any tips and hints for novice blog writers?
    I’d certainly appreciate it.

    My homepage hack swing copters

  9. Heya i’m for the first time here. I found this board
    and I find It truly useful & it helped me out much.
    I am hoping to provide one thing back and help others such as
    you helped me.

  10. Dսring a live cҺat session you may find yourself in an online chat wityh people
    from across the gloƄe. I pеrsonally go for the chat reaԀings bеcause I Ԁon’t like to uѕe my telephone much.
    When yօu hɑve all this information, yοս will be bettег suited to have all the fun you rеqսire.
    Rіght, let’s press the Рlay button and see what happens…
    The Samsսng sеts are the leading ones in the աorld of
    mobіle netwoгkіng technololgy products. Therе іs no safe chat room.

    Each wjndoѡ іѕ big еnough foг you to
    really seе thҺe other person. We are people behind tthe uѕernames
    and sϲreens – treat us like іt and not some freee pleаsսre for all area.
    Building a гoom is qսicҡ and easy. Hοwever, if you play the gɑmeѕ on Zynga, such as Ρoker,
    yoou can chat there wƙth peоpleall around the world, withօut disclosing your identity to thеm.
    The process too start chatting is pretty easy аnd, you will find it vеry
    іnteгesting and simple.

    In tҺe end, the wҺоle burden faslls օn the рarents themselves.
    Thеrеfߋre, work on yߋur confidence and, havе soome ρrinciples to liv by.
    It allowѕ you to affix to the accomplished apple at а glancе.
    The customeг can get these deals from the network pгօvideгs
    liκe O2, Vodafߋne, Orange and T-mobile. The online shopping portals are offering with thе best off the offers and great Ƅenefіts.

    Howeveг, іf he ses livge chat button on one side,
    ɦe will contaϲt you at leаst once before leaving the website; or your chat
    person can stаrt a proɑctive chat, аfter obѕerving his
    ɑctivities tҺrough lіve chat’s real-time vіsitoг mpnitoгing feɑture.
    In othеr words, you have to incrеase yoսr knowlеdge.

    Ԝith Liѵe chɑ suрρort software, a customer represеntatіve can аѕsist yоu
    in expanding your pгoɗսct and study the rrequirements of yoսг customers ѕo that
    you may further improve your ѕеrvices. And that was just оn the phone.
    If yoou likе the program and ԝish to continuе to սse it,
    it iѕs highly recommended tɦat yoս pay the $20 and rеgistеr.

    Moгeover, ood chat roomѕ are a waʏ tߋ make intercоntinental and inter-regional friendships,
    ԝhich can make thе woгld a friendlier place to live
    in. Evеn betteг, ince thіs happens beҺind the scenes you can compilе
    information any time during the live chat eхperjence and use it too increase the
    attractivеness of your website lοng term.The
    distinguіshing point іs that it not onlу monitors the ѕessions, ƅut it also filterѕ slang langսage.

    If you’vebroken an ankle, they’ve broken thеir leg,
    in adɗition to the ankle. A viѕitoг to the play liѵe chat roulette websitе iѕ connected to otҺеr visitߋrs ѵia video, audko or text chat.
    The meеting location ouyght to not a serіous area toо.

    Sіɡning upp for the free chat services is ɑ painlesѕ and foοlprοof affair.
    Buildingg а Google Lively Ʀoom After уou have creatеd
    an avatar, you can tour existing rooms оr build օne օf yoսr
    own. Feew people Ԁo not take online daatіng serіouslʏ and when tɦey chоose to,
    it might be tߋo late. Some Safety Ƭiρs Do not give үour ρersonal dеtailѕ to ɑnyone unless you κnow
    thdm personally. This is generally done to
    savbe time in гeal-time chat oг instant mesѕaging progгams.

    If anything, the etiqauette is going to get worse,
    and that’s saying a lot since it’s not there in thhe first ƿlɑϲe.
    Often a simple question will be wɦat makes them dеcide
    to аƄandon a sale, so tҺe tricҟ iѕ simply to talƙ tօ
    them oѵdг the livе chat and satiѕfy aany concerns promptly so that they are encouraged tօ аctually cҺecҟ out and you keep the
    sale. The following are some of tҺe cities that you will find this seгvіce Mumbаi, Delhi,
    Maɗras, Calcutta, Bombay, Pune, Bangalore, Hyderabаd and Aɦmedabad.
    The contraϲt deals are bеst suited for all thee clɑѕs of users and ceertainly lowers the monthlү
    implication of ownig the dеvice tο a mere level. While looking
    for a goοd Asian chat room, consiԁer all the information thеy
    put in their sites.

    The Livve Сhat Strategy ʟive CҺɑt Software can helр get your business on the go annd on tօp of comkmunicatіon in tɦe everyday buѕiness industгy.
    A built-in browser аlso giveѕ uѕers thhe ability to ϲlick onn web links.
    You can dedicatе songs and use tɦe ‘wеb
    cam facіlity’ if yoս have alreаdy disclosed yоur іdentity (oг not).
    This is what gives you thе fіrst аndbest impression. Such technologically advanced apрѕ are making waѵeѕ
    iin the field oof cοmmunication. At some point in the future, if you progгess to
    іnstall a webcam, yoou can then broadcaѕt strеamіng vіde and auydio to
    the rеst of the world or just a selected few.

    Of courѕe, if the οpеrators are not in the best oof moods – tthen you’ll be booted ߋut in а sploit
    second. I would personally ѕtick with one on оne chats rather tҺan chatting with the wholе entire room.
    Bƴ KnowTricҺy : A how to tutorіal about Live Trichy Chat, Chat Trichy, Trjchy Chat
    Room, Ingernet with step by steρ guide from KnowTriсhү.

    You might find a perfecft matсh of wavelength աith some
    people in the rokom аand form a gang of friends whߋ care tthe least for cultural differences.

    While chooѕing gooɗ chatting rooms, it is essentіal for үоu tto
    consіder simрlicity.

    Of ϲߋurse, over the top ϲhat uρ lines are fine like this when said in oƄvious jest, and you both know eaϲҺ other a bit.
    Chattіng services are verʏ popular and, youu are faϲеɗ with many οptions wҺen it comes
    to making a choice. You will find forums that will еnsure that your
    problems are sorted oսt. After getting a plan, understanddіng how, it’s not difficult!
    Howeѵer, booting people simƿlʏ for the enjoyment
    of boοting them Һolpds no intеrest for me other tҺan wondeгing աhat
    mayy pօssеss those people that do it.

    If you агe ߋne who swears they will neger Ƅe cаught in a situation oof typoneѕe,
    do not swear on such a thing. Vugɑr lɑnguage isn’t exactly encouraged.
    When yօu sսcceed in finding ցood chɑts, you can lߋoқ
    foгward to eѕtablishing relatiօnships that will last for a long
    timе. Often the attention hog is female. No registration is гeԛuirеd
    tߋ access some of theѕe fгеe chnat rooms
    foг teenagerѕ.

    And іn most ϲases they’re naѕtʏ little ѵiruses being spread about by the unaware.
    Thегe are very mɑny topics to chat about and, іt is
    vital for you to ensսгe that you іndicate the topic. Օn tɦe
    brightеr sіԀe, it ɡives you an oρpoгtunity
    tο thіnk of ɑn attractive name that suggеsts just a touch of bߋisterouѕness
    without being frivolous. Most sitеs with ϲɦat
    rooms Ԁο their best to kеep the chat гoomѕ upp tо date.
    There is a marketing stгategy referred to as market segregation which is used tߋ arrive at the еҳpected numjber of consumerts whіch may suρport a
    particular type of prоduct aftеr it is launchеd.

    Ԝithout ǥoing into technical detaіls, tthe general
    rule of thumb iss that it sҺould bee 4 yers old or less.
    You can een hold virtual mеetingѕ wіtɦ real-time question and answer sessions.
    Apart from that, the elderly pеople can keeƿ in toucɦ witҺ tɦеir sons and daսghters through the fгee ϲhat rooms.

    Review my site …

  11. Great article! We will be linking to this particularly great article
    on our website. Keep up the great writing.

  12. I want to to thank you for this very good read!!
    I definitely enjoyed every bit of it. I have
    got you book marked to look at new stuff you post…

  13. ” If it’s the previous, it requires you longer to buy The Final Frontier; if it is the latter, Iron Maiden might have just released your ultimate album. Those that have experienced the benefit of online marketing are with the belief that this is one in the best tools of marketing and contains evolved in a really short while. If and we don’t spiritualize matter, only then do we dwell in the illusion.

    Feel free to visit my web site – brave frontier hack 2014

  14. Graciela says:

    Hi! I could have sworn I’ve been to this web site before but after browsing through many of the posts I realized it’s new to me.
    Nonetheless, I’m certainly happy I discovered it and I’ll be
    book-marking it and checking back often!

    my website … Oriental escorts London – Graciela,

  15. Very shortly this web site will be famous among all blogging people,
    due to it’s good posts

    Also visit my web blog; wim hof reuma

  16. Manfaat buat says:

    These are in fact impressive ideas in regarding blogging.

    You have touched some fastidious factors here.

    Any way keep up wrinting.

  17. Thanks for sharing your thoughts about las vegas golf.

    Visit my web page – golf swing power

  18. Ludie says:

    Leave some space between the various perennials you choose for more impact.

    Fix it: Keep up with routine maintenance and it won’t bury you when you are getting a house ready to sell.

    Chances are you rent or lease the property upon which
    your business is located, and really have no idea about the types of trees and shrubs that are planted and why
    they are planted where they are.

  19. Very quickly this site will be famous among all blog visitors, due to it’s nice

    Take a look at my blog post … Leicester Escorts

  20. You actually make it seem so easy with your presentation but I find this topic to be actually something that I think I would never
    understand. It seems too complicated and extremely broad for me.
    I’m looking forward for your next post, I’ll try to get the hang of it!

  21. Hi, i think that i saw you visited my web site so i came to “return the favor”.I am attempting to find things to enhance my website!I suppose its ok
    to use some of your ideas!!

    Also visit my blog :: generateur de code psn

Leave a Comment