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31-05-2012 | Sports medicine | Article

Holistic approach needed for back pain control

Abstract

Meeting website

MedWire News: Researchers have found that occupational factors and depression can delay the recovery process in patients with low back pain (LBP).

Presenting the findings at the 13th Congress of the European Federation of National Association of Orthopaedics and Traumatology (EFORT) in Berlin, Germany, Markus Melloh (University of Western Australia in Nedlands) stressed the need for consideration of psychosocial and psychologic problems in patients in order to prevent back pain becoming chronic.

The researchers studied the effects of occupational factors on LBP in patients attending their health practitioner with their first episode of acute or subacute LBP over a 6-month period.

From their analyses, they devised a four-predictor model that predicted 51% of variance in persistent LBP. The four elements of the model included "resigned attitude towards the job," "functional limitation," "duration of LBP," and "social support at work."

The researchers found that both functional limitation and duration of LBP increased the likelihood for persistent LBP, but resigned attitude towards the job had the greatest impact, increasing the likelihood by 73%. By contrast, social support at work was a protective factor, reducing the risk for persistent LBP by 46%.

"As so often with back pain, physical causes and medical solutions are not the only priority aspects. Psychosocial problems must also be recognized and resolved," Melloh said in a press statement.

"Workplace interventions have the potential to save people from experiencing chronic pain."

The team also looked at whether depression affects recovery in acute LBP patients. They assessed 287 patients with a first episode of acute LBP (≤6 weeks), 18% of whom were depressed. All the patients had high pain intensity, high functional limitation, and high job stress.

Depression had a negative impact on recuperation, with back problems remaining especially intractable after 6 weeks of treatment in affected patients, whereas patients without depression showed definite signs of improvement.

"My recommendation for health practitioners treating depressive patients with acute back pain would therefore be to keep close watch on their patients' psychological state because those have a worse chance of recovery," Melloh said.

"Accompanying measures and activities such as counseling with psychologists, participation in a self-help group, or the use of antidepressive medications would be advisable."

By Lucy Piper

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