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Intensive
education helps back pain sufferers get back
to work
Newswise — People who
suffer from short-term lower back pain might
be able to return to work sooner if given an
intensive individual patient education
session from their health care provider,
according to a new review from researchers
in the Netherlands.
Health care providers
often use patient education to help patients
better understand back problems and what
they can do about them.
This can include how to
stay active and return to work as soon as
possible, how to cope with having back pain
and how to avoid strain and reduce the risk
of back pain episodes in the future.
“The main goal in the
treatment of nonspecific low back pain is to
stimulate the patient to remain or become
more active despite the pain, in a
time-contingent manner,” said lead reviewer
Arno Engers, of the Radboud University
Nijmegen Medical Centre.
“Different
interventions are advised, but the main goal
in most cases is to change the orientation
in the patient from a pain focus to an
activity focus.”
The aim of the
systematic review was to determine whether
individual patient education is an effective
piece in the treatment plan of lower back
pain.
The review appears in
the current issue of The Cochrane Library,
a publication of The Cochrane Collaboration,
an international organization that evaluates
research in all aspects of health care.
Systematic reviews draw
evidence-based conclusions about medical
practice after considering both the content
and quality of existing trials on a topic.
The Cochrane reviewers
write that lower back pain is a common
disorder that can cause a “great deal of
pain,” lost activity and work absenteeism.
They analyzed 24
studies that included adults who suffered
from lower back pain — both short-term and
long-term (chronic).
The studies used
different types of patient education,
including a discussion with a health care
provider, a special group class, a booklet
or pamphlet with written information to take
home, or a video.
Some studies looked at
patients having these different types of
interventions along with their usual care,
and other studies compared intervention
patients with those receiving only their
usual care and no patient education.
The reviewers found
that for patients with short-term lower back
pain, having a 2.5-hour individual patient
education session with a health care
provider was more effective in speeding up
their return to work than having no patient
education.
For example, after
seven months, 30 percent of patients who had
received at least a 2.5-hour session were
still on sick leave compared with 60 percent
of those who received no intervention.
It was unclear which
type of patient education was most
effective, but Engers and colleagues
concluded that patients who suffer from
chronic low back pain are less likely to
benefit from any type of patient education.
Moreover, while the
review found that 2.5-hour individual
sessions were most effective, Engers
acknowledged this length of time is not
often devoted to one-on-one patient
education in today’s health care
environment.
“To our knowledge,
general practitioners have very limited time
and it is presumed will take about 10 to 15
minutes for a total consultation, patient
education included,” Engers said.
“An extra problem in
individual patient education is that it’s
often not seen as an ‘intervention’ at all,
not by physical therapists, or by patients
or health insurance institutes.”
Roger Chou, M.D.,
associate professor of medicine at Oregon
Health & Science University and the director
of clinical guidelines development at the
American Pain Society, agreed that patient
education sessions of this length are rare.
“Most of the studies of
intensive educational sessions were
conducted in Europe, usually in countries
where there is a very different system for
caring for injured workers,” Chou said.
“In the U.S., I think
it is very uncommon outside of a few
specialized clinics to provide the kind of
intensive education that the Cochrane review
found effective due to time and
reimbursement issues.”
Chou added that low
back pain sufferers do find relief from
other types of treatments.
“Most people with acute
low back pain experience substantial
improvement in the first few weeks,” he
said.
“Many of the effective
treatments for acute low back pain are
simple ones, like over-the-counter pain
medications such as acetaminophen and
ibuprofen, remaining active, and using
heating pads.”
The Cochrane
Collaboration is an international nonprofit,
independent organization that produces and
disseminates systematic reviews of health
care interventions and promotes the search
for evidence in the form of clinical trials
and other studies of interventions. Visit
http://www.cochrane.org for more
information.
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