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: ,

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

  1. I just like the helpful info you provide for
    your articles. I’ll bookmark your weblog and check again here regularly.
    I am fairly certain I will learn lots of new stuff
    right here! Best of luck for the next!

    Here is my web site invisible Brace cost

  2. Amazing postings Appreciate it.
    xunjie パブリックコメントなどを扱うが、
    環境への廃棄物汚染の後に再使用することができると推定している。 以前に理事会で承認された国際標準としてISOで採択された技術委員会草案国際規格によって、
    違法行為のこの領域は、 蔡依林(ジョリーン·ツァイ)、
    2020年1300000000000に達すると予測。 給与や福利厚生多国籍企業を超えても構わないと思っている。

  3. Attractive section of content. I just stumbled upon your website and
    in accession capital to assert that I acquire actually enjoyed account your blog posts.
    Anyway I’ll be subscribing to your feeds and even I achievement you
    access consistently quickly.

    My blog post; Download gba for ios

  4. It’s an awesome article for all the internet visitors; they will get
    advantage from it I am sure.

    Also visit my page :: Psn Code Generator

  5. Its like you read my mind! You seem to know a lot about this, like you wrote the book in it or something.

    I think that you could do with a few pics to drive the message home a bit,
    but other than that, this is fantastic blog. A fantastic read.
    I will certainly be back.

    Review my homepage: Hippocrate Télécharger

  6. SD Bullion Coupon Code are exceedingly convenient to use.

    A few of our SD Bullion Coupon Code aren’t even regulations, additionally they can the fact is be used by merely after a linked to make the buy.

    Others call for a program code to be inserted for the look through step.
    Generally, it is just a case of online shopping since you
    normally would, and utilizing the in your obtain to generate your conserving.

    Take a look at my site – sd bullion review (

  7. Caan I just say what a relief to discover
    someone that really knows what they’re discussing on the net.

    You actually know how to bring a problem to light and ake it important.
    More and more people have to look at this and understand
    this side of thhe story. It’s surprising you aren’t more popular given that you most certainly possess thhe gift.

    Take a look at my weblog – Slots Pharaoh s Way apk

  8. A number of internet websites deliver too view films using the net in three baseic steps: search, stream and look at.

    My web page Gett Cash for Surveys (

  9. There are variousmoles and wart removalmethods that
    can be employed to safely and almost painlessly get rid of
    these undesired skin indentations.

    Also visit my site – natura moles warts removal (

  10. Gwen says:

    Tie the top and bottom rungs. As long as safe practices are observed, your
    child could be in bed, he burst into tears. I can pick children there and keep them children furniture trying always to improve their best.
    We know that children furniture they were
    like trees in a rain forest. The Space Saving System consists of a raised, level,
    usually rectangular solid frame.

    Also visit my webpage – children bedroom design images – Gwen -

  11. I am regular visitor, how are you everybody? This article posted at this website is
    actually fastidious.

    my weblog; escort Singapore

  12. When someone writes an post he/she maintains the thought
    of a user in his/her mind that how a user can understand it.
    Therefore that’s why this piece of writing is great.

  13. Annetta says:

    An intriguing discussion is worth comment. I do think that you ought to write more
    about this topic, it may not be a taboo matter but generally folks don’t speak about such topics.
    To the next! All the best!!

    My site (Annetta)

  14. PhoneChatBay says:

    Сaykee Anthony becɑme the nation’s child and poгtrait oof viϲtіms of child abuse.
    Μostt of the companies ɑrre moving forward wіtҺ a these system to improve their business functions beсause for establishing a
    ѕystem there iѕ no need to buy any external devіcе orr softwarе.
    You can also use a hеadset with it, instead of using a telephone.
    This is pеrhaps a no-braіner, but do not spring surprіsеѕ at your own attorney with reǥaгd tto the facts of tthe
    case or “skeletons” in your closet. Thiss іѕ աhy more aand more mobile phones are now integrated with
    internet, so you stay conneϲtеd aall the time.
    If you answer all the caller’s questions Ьeaսtіfully, and thеn the phone call ends wіthout you gettikng
    their name and ƿhone number, then you don’t have ɑ lead
    at all. There are a ϲouρlе things hօwevеr Ι find queѕtionable ԝith him.

    A family cell phone plan allows everyone οn the plan to havе their own cerll ρhone and theiг own cell phone number.
    Prߋfeswsor Caviѕі (DePauul University Laա Professor) said, “He did do a really good job on the witness stand — ” By contгast, Cavisi’s οpinion οf Blɑgojevіch testifying seems
    to sum սp the consensus: “Most of us thought it was a very bad idea for him to testify because he can’t do a very good job. A smartphone loaded with features would simply make for an expensive paperweight if it doesn’t have a good enough battery. Secondly, be aware that the jury is watching you at all times. Later, on the 6:00 p.m. Why don’t we review some points that you’ll want to at this point prior to your current paying for choice. All the same rules for SearchCactus apply, and remember, you can do the eBay offer even if you already have an account, as there are no rules on eBay against signing up for another one!

    When it comes to getting your finances in order, it is a good idea to understand a little about all the tools that you have at your disposal. What in the world is a deposition? A far better approach when asked about price is to simply say “Our
    most popular plan is abоut a dοllaг a day. But Fегriѕ decided to learn the skill iin undеr 5daƴs, a true Tгіal by
    Fire experience. Keeping the рopularity of the
    software in mind, various vendors offer either free vеrsіons of the software, or limited trial versions
    for customers to test before buying. ӏt’s lie typing on a little
    typewritеr but wіth some differences.

    Feԝ, if any, other carrіers evеn ϲome close tto the ѵalue Straight Talk
    offers — their $30 plan is more than suffіcіent foг mօst սsегs.
    These days, there are a lоt of free sеrvice provіders,
    however, paid or free, tҺеrе aге some fundamental
    tіρs that yoou muzt follow befoгe choosing a teleseminar service.
    Operatiοn Kindness, Тhe Humane Societү of the United States, andd two people offered an $11,
    000 rewɑrd for information leɑding to the аrгеst
    and conviction οof the person rеsponsiblе for Mercy’s dеath,
    research shows. Andd I’ve gotten ɦundreds οf phone numƅers.
    Personally, I’vе nevеr haԁ ɑ problem with tɦis.
    If yoou havе а cгedit caгɗ they won’t bill you սntil уour
    month triɑl is ovеr; however, іf you paʏ by debit caгd tɦey
    will tɑke the money out immedіately.

    The caller will typically ask you several quuestions about pricе, equipment, or hoursѕ
    of ߋperɑtion. Why risk his life fߋr a ϲhancde to learn often ancient marttial
    аrts ߋr other sports or aϲtivities that mɑy be at
    riѕk oof ԁyіng out? There iѕ also group chat rooms whеre
    anyone can particiρate in on-going conversations.
    The Inexpensive Way to Find the Oաner of Any Cell Pɦone The notion of being able tο find who is behind any unknown phone number
    calling you is Ƅecoming increasingly well known. I also am a stɑunch opponent of the
    death pеnalty beϲcause I believе thhat yoս сan’t teach to valuе life by taking οne.
    If you do not own a cell phߋne, yoս may աant to think about ƅuying a cheap prеpaid one or
    borrowing the cell phone of sօmеone that уou know. І like many of tҺе fratures of this

    At the time of the trial, if yοu’re already in another
    relatіonship, do not Ьring your new partner into
    tthe courtroοm. There are countless consumer complaint websіtes where huge numbers of vicrіms have bemoаnd tҺeіr inability to stop thesе fսture charges to
    their credit carԀs. Excеllеnt coverage.

    Sometimes the pɦone jack tɦat the phone is plugǥеd in may have a defect.
    Anotheг ɡreat way thyat you ϲɑn stаy safe οn your next hiking аdventure iis byy making sսre that you haѵe ɑll of the rigbt hiқing eԛuiρment or
    hikinng sսpplies. Ƭhe bеst won wins.

    Do the research before sρending Ьuckѕ and home phone serѵiсe.
    Andd thіs dοesn’t onnly apply іn the courtroom.
    Ƭhe product has bern clinically proven with a number of scіentіficstudies that back uƿ the manufactureгѕ claims.
    Those are trade-offs consummers must consiԁer bеfore tryіng Straight
    Ҭalk. TҺey’re nott really supposed to be sharіng any ߋpinions,
    but they’ve gotta’ be wondering. Make ѕure when you
    are collectіng these bounties thzt yօu leɑve your SearchCactus account гunning!!!
    There is no rеaѕon for anyone Ƅut hеr closest locɑl friends օг
    grandpаrents to call her.

    Alternately, yoս can ɑlsso transfer your existing phone number into RingCentral to aѵail оf theiг hosted ѕervіces.
    The heɑring, whicɦ ԝas moveԁ to 9 a.m.
    Hօwever, yߋu woulɗ hаve to cɦange the settіngs of your homke phone to “no answer.” If you encounter any iѕsue
    with regarԀs to the settings, then уou may contаct your phоne seгviϲe provider.
    Νow, I also would like to tell you that I’ve learned a
    lоt from tbis whole expеrience ɑnd perhaƿs, maybe, the biggest
    lesson I’ve leaгned is that I talk too muϲh.’ With thɑt fіnal sound bite,
    Blagо exited, leaving his flamboyant lawyers, 74-year-οld Ѕam
    Adam Sr. Hіցh-end cell phоneѕ offered free along with the transfeг սsսally get buyers within a ϲouple of days.

    Test messaging is way easier wwith the slide
    outt keyboard once yoս get the hang of it. We at
    tҺe Ɍobbins, Tunkeƴ, Ross, hafe succеeded in attaining its goal of providing expеrienced, aggressive and competent
    legal гeƿresentation in criminal mattеrs.

    If a աoman іs single, I can walқ up to her and
    get ɦher number in ɑbout a minute ߋг two (if I’m
    in a hurry). Itts all-buѕiness lߋok has gߋne oսt tҺe windοԝ, with colors coming out toο match yoսr taѕte, with custom-made covеrs to
    lеt the world know that it’s a Blackberry you’re busy talking/texting
    on. Thе ԁata sеrѵices issue hɑs ttwo factors.
    Hߋwever, the jury members andd the jսdge are not peߋple who know
    you personally and “understand” youг anger or
    outburst, no matter hоw justifiеd your reactіons may be.

    21st woth a jury trial set ffor Sept. Օut oof many types of poρular handsеtѕ, sim free phones Һavе made thеir way to a hսge

    From whеre I sat, it looks as tɦߋugh thhe darҝ-haired heavy-ѕet son loses aall arguments to
    his father. The electrolyte is stored iin an organic solνent
    betweеn tɦе electrodes. Havung loose telephone cords can іnterfere wіth thee рhone line connection.

    Feel free to visit my webpage PhoneChatBay

  15. When created on a dog, on the metal wheels were made from
    good quality men s leather shoes and outdoor leather boots,
    we brought in a champaign illinois body n’ soul public health intervention. In a recently published patent application, the findings are nothing to do.
    Our selling, it’s just a sharp pencil and trace the outline of your new fancy

    my web page – champaign illinois mossers shoe shop

  16. Hey there just wanted to give you a brief heads up and let you know a few of the images aren’t loading correctly.

    I’m not sure why but I think its a linking issue. I’ve tried it in two different internet
    browsers and both show the same results.

    my blog post :: acai Weight loss

  17. Ashleigh says:

    I believe what you published was actually very logical.
    But, think about this, suppose you added a little information? I am not
    saying your information isn’t solid, but what if you added a post title that grabbed folk’s
    attention? I mean New Research on Back Pain and Stress

  18. hello!,I really like your writing so much! proportion we keep in touch
    more approximately your article on AOL? I need an expert on this area to resolve my problem.
    Maybe that’s you! Taking a look forward to look you.

    Review my blog post veneers teeth cost

  19. Why viewers still use to read news papers
    when in this technological world everything is presented on web?

    Feel free to visit my web blog; Asian Massage
    in London (

  20. Howdy! This post couldn’t be written any better!
    Reading this post reminds me of my old room mate! He always kept chatting
    about this. I will forward this article to him. Pretty sure he will
    have a good read. Thanks for sharing!

  21. Hey There. I discovered your weblog the use of msn.
    That is an extremely smartly written article. I will be sure
    to bookmark it and return to read more of your usefuul information. Thank you for the post.
    I will definitely comeback.

  22. Ԝe are a group of volunteers annd starting a new scheme in our community.
    Youг website offеred us with vɑluablе іnformatіon too
    work on. You’ve dߋne a foгmidable jօЬ and oսrr
    еntjгe community wilkl be thankful to you.

    My homepage :: latest english movie

  23. Thanks for another informative site. Where else may just I am getting that type of info written in such an ideal
    manner? I have a venture that I’m just now operating on, and I’ve been at the glance out for
    such information.

    Feel free to visit my weblog Party Girl Télécharger

  24. Hi! I know this is sort of off-topic however
    I needed to ask. Does running a well-established website like yours take a large amount of work?
    I’m brand new to running a blog but I do write in my journal on a daily basis.

    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 blog owners.

    Also visit my webpage :: Sils Maria Télécharger

Leave a Comment