The feasibility and effectiveness of a new practical multidisciplinary treatment for low-back pain: A randomized controlled trial

Journal of Clinical Medicine

Volumn 9, Issue 1, 2020, Pages

  Wippert, Pia Maria ^a,b   Drießlein, David ^c   Beck, Heidrun ^d   Schneider, Christian ^e   Puschmann, Anne Katrin ^a   Banzer, Winfried ^f   Schiltenwolf, Marcus ^g  

^a UNIVERSITY OF POTSDAM   (Germany)

^b ETH ZURICH   (Switzerland)

^c UNIVERSITY OF MUNICH   (Germany)

^d UNIVERSITY HOSPITAL CARL GUSTAV CARUS   (Germany)

^e Orthopädiezentrum Theresie   (Germany)

^f GOETHE UNIVERSITY   (Germany)

^g UNIVERSITY HOSPITAL HEIDELBERG   (Germany)

Author keywords

Classical conditioning; Executive function; Low back pain; MiSpEx Network; Multidisciplinary pain treatment; Sensorimotor exercise training

Indexed keywords

ADULT; AGED; ANXIETY; ARTICLE; BEHAVIOR THERAPY; CHRONIC PAIN GRADE QUESTIONNAIRE; CLINICAL OUTCOME; CONTROLLED CLINICAL TRIAL; CONTROLLED STUDY; COST CONTROL; EXERCISE; EXHAUSTION; FEAR AVOIDANCE BELIEFS QUESTIONNAIRE; FEASIBILITY STUDY; FEMALE; FOLLOW UP; HOSPITAL ANXIETY AND DEPRESSION SCALE; HUMAN; LOW BACK PAIN; MAJOR CLINICAL STUDY; MALE; MENTAL HEALTH; MULTICENTER STUDY; MULTIDISCIPLINARY TEAM; PAIN VIGILANCE AND AWARENESS QUESTIONNAIRE; PERCEIVED STRESS SCALE; PROGRAM EVALUATION; QUESTIONNAIRE; RANDOMIZED CONTROLLED TRIAL; SENSORIMOTOR FUNCTION; SINGLE BLIND PROCEDURE; THERAPY EFFECT; TRAINING; VISUAL ANALOG SCALE;

EID: 85087774289     PISSN: None     EISSN: 20770383     Source Type: Journal    
DOI: 10.3390/jcm9010115     Document Type: Article

References (68)

1. Institute for Health Metrics and Evaluation. Disease and Injury Incidence and Prevalence Collaborators. Global, regional, and national incidence, prevalence, and years lived with disability for 328 diseases and injuries for 195 countries, 1990–2016: A systematic analysis for the Global Burden of Disease Study 2016. Lancet 2017, 390, 1211–1259.
2. Foster, N.E.; Anema, J.R.; Cherkin, D.; Chou, R.; Cohen, S.P.; Gross, D.P.; Ferreira, P.H.; Fritz, J.M.; Koes, B.W.; Peul, W.; et al. Prevention and treatment of low back pain: Evidence, challenges, and promising directions. Lancet 2018, 391, 2368–2383.
3. Techniker Krankenkasse. Gesundheitsreport 2014—Veröffentlichungen zum Betrieblichen Gesundheitsmanagement der Techniker Krankenkasse; Techniker Krankenkasse: Hamburg, Germany, 2014.
4. Buchbinder, R.; van Tulder, M.; Öberg, B.; Costa, L.M.; Woolf, A.; Schoene, M.; Croft, P.; Hartvigsen, J.; Cherkin, D.; Foster, N.E.; et al. Low back pain: A call for action. Lancet 2018, 391, 9–15.
5. National Association of Statutory Health Insurance Physicians; Association of the Scientific Medical Societies in Germany. Nationale Versorgungsleitlinie Nicht-Spezifischer Kreuzschmerz—Langfassung. National Therapy Guideline for Non-Specific Low Back Pain; National Association of Statutory Health Insurance Physicians; Association of the Scientific Medical Societies in Germany: Berlin, Germany, 2016.
6. Nicholas, M.K.; Linton, S.J.; Watson, P.J.; Main, C.J.; “Decade of the Flags” Working Group. Early identification and management of psychological risk factors (“yellow flags”) in patients with low back pain: A reappraisal. Phys. Ther. 2011, 96, 1–17.
7. Maher, C.; Underwood, M.; Buchbinder, R. Non-specific low back pain. Lancet 2017, 389, 736–747.
8. Engers, A.J.; Jellema, P.; Wensing, M.; van der Windt, D.A.; Grol, R.; van Tulder, M.W. Individual patient education for low back pain. Cochrane Database Syst. Rev. 2008, doi:10.1002/14651858.CD004057.pub3.
9. Heymans, M.W.;van Tulder, M.W.; Esmail, R.; Bombardier, C.; Koes, B.W. Back schools for non-specific low-back pain. Cochrane Database Syst. Rev. 2004, 4, doi:10.1002/14651858.CD000261.pub2.
10. Henschke, N.; Ostelo, R.W.; van Tulder, M.W.; Vlaeyen, J.W.; Morley, S.; Assendelft, W.J.; Main, C.J. Behavioural treatment for chronic low-back pain. Cochrane Database Syst. Rev. 2010, CD002014, doi:10.1002/14651858.CD002014.pub3.
11. Saragiotto, B.T.; Maher, C.G.; Yamato, T.P.; Costa, L.O.; Costa, L.C.M.; Ostelo, R.W.; Macedo, L.G. Motor control exercise for chronic non-specific low back pain: Cochrane review. Cochrane Database Syst. Rev. 2016, doi:10.1002/14651858.CD012004.
12. Kamper, S.J.; Apeldoorn, A.T.; Chiarotto, A.; Smeets, R.J.; Ostelo, R.W.; Guzman, J.; van Tulder, M.W. Multidisciplinary biopsychosocial rehabilitation for chronic low back pain. Cochrane Database Syst. Rev. 2014, doi:10.1002/14651858.CD000963.pub3.
13. Hancock, M.J.; Maher, C.G.; Laslett, M.; Hay, E.; Koes, B. Discussion paper: What happened to the ‘bio’ in the bio-psycho-social model of low back pain? Eur. Spine J. 2011, 20, 2105–2110.
14. Wippert, P.-M.; Wiebking, C. Stress and Alterations in the Pain Matrix: A Biopsychosocial Perspective on Back Pain and Its Prevention and Treatment. Int. J. Environ. Res. Public Health 2018, 15, 785.
15. Faul, F.; Erdfelder, E.; Lang, A.G.; Buchner, A. G* Power 3: A flexible statistical power analysis program for the social, behavioral, and biomedical sciences. Behav. Res. Methods 2007, 39, 175–191.
16. Wippert, P.-M.; Wippert, P.-M., Niederer, D., Drießlein, D., Beck, H., Banzer, W., Schneider, C., Schiltenwolf, M., Mayer, F. The Chicken-Egg-Affair: Moderators and Mediators of the responsiveness to exercise in low back pain: A Randomized Controlled Trial. Br. J. Sports Med. 2019, under review.
17. Mayer, F.; Arampatzis, A.; Banzer, W.; Beck, H.; Brüggemann, G.P.; Hasenbring, M.; Kellmann, M.; Kleinert, J.; Schiltenwolf, M.; Schmidt, H.; et al. Medicine in Spine Exercise [MiSpEx]—A National Research Network to evaluate Back Pain in High-performance Sports as well as the General Population. Ger. J. Sports Med. 2018, 69, 229–235.
18. Hönning, A.; Stengel, D.; Güthoff, C. Statistical strategies to address main research questions of the MiSpEx network and meta-analytical approaches. Ger. J. Sports Med. 2018, 69, 236–239.
19. Wippert, P.M.; de Witt Huberts, J.; Klipker, K.; Gantz, S.; Schiltenwolf, M.; Mayer, F. Beschreibung und empirische Fundierung des verhaltenstherapeutischen Moduls der MiSpEx-Intervention. Schmerz 2015, 29, 658–663.
20. Hayden, J.A.; Cartwright, J.L.; Riley, R.D. Exercise therapy for chronic low back pain: Protocol for an individual participant data meta-analysis. Syst. Rev. 2012, 1, 64.
21. Saragiotto, B.T.; Maher, C.G.; Yamato, T.P.; Costa, L.O.; Costa, L.C.M.; Ostelo, R.W.; Macedo, L.G. Motor control exercise for chronic non-specific low back pain: A Cochrane review. Spine 2016, 41, 1284–1295.
22. Geneen, L.J.; Moore, R.A.; Clarke, C.; Martin, D.; Colvin, L.A.; Smith, B.H. Physical activity and exercise for chronic pain in adults: An overview of Cochrane Reviews. Cochrane Database of Syst. Rev. 2017, doi:10.1002/14651858.CD011279.pub3.
23. Owen, A.M.; McMillan, K.M.; Laird, A.R.; Bullmore, E. N-back working memory paradigm: A meta-analysis of normative functional neuroimaging studies. Hum. Brain Mapp. 2005, 25, 46–59.
24. Standaert, C.J.; Weinstein, S.M.; Rumpeltes, J. Evidence-informed management of chronic low back pain with lumbar stabilization exercises. Spine J. 2008, 8, 114–120.
25. Burciu, R.G.; Fritsche, N.; Granert, O.; Schmitz, L.; Spönemann, N.; Konczak, J.; Theysohn, N.; Gerwig, M.; van Eimeren, T.; Timmann, D. Brain changes associated with postural training in patients with cerebellar degeneration: A voxel-based morphometry study. J. Neurosci. 2013, 33, 4594–4604.
26. Vivar, C.; Potter, M.C.; van Praag, H. All about running: Synaptic plasticity, growth factors and adult hippocampal neurogenesis. Curr. Topics Behav. Neurosci. 2013, 15, 189–210.
27. Erickson, K.I.; Gildengers, A.G.; Butters, M.A. Physical activity and brain plasticity in late adulthood. Dialogues Clin. Neurosci. 2013, 15, 99–108.
28. Naugle, K.M.; Fillingim, R.B.; Riley, J.L. A Meta-Analytic Review of the Hypoalgesic Effects of Exercise. J. Pain 2012, 13, 1139–1150.
29. Hoeger Bement, M.K. Exercise-induced hypoalgesia: An evidenced-based review. In Management and Mechanisms of Pain for the Physical Therapist; Sluka, K.A., Ed.; Wolters Kluwer: Alphen aan den Rijn, The Netherlands, 2009.
30. Dapunt, U.; Gantz, S.; Zhuk, A.; Gather, K.; Wang, H.; Schiltenwolf, M. Quantitative sensory testing in physically active individuals and patients who underwent multidisciplinary pain therapy in the longitudinal course. J. Pain Res. 2018, 11, 2323–2330.
31. Niederer, D.; Vogt, L.; Wippert, P.M.; Puschmann, A.K.; Pfeifer, A.C.; Schiltenwolf, M.; Banzer, W.; Mayer, F. Medicine in spine exercise (MiSpEx) for nonspecific low back pain patients: Study protocol of a multicentre, single-blind randomised controlled trial. Trials 2016, 17, 507.
32. Mueller, J.; Stoll, J.; Mueller, S.; Mayer, F. Dose-response relationship of core-specific sensorimotor interventions in healthy, well-trained participants: Study protocol for a (MiSpEx) randomized controlled trial. Trials 2018, 19, 424.
33. Arampatzis, A.; Schroll, A.; Catalá, M.M.; Laube, G.; Schüler, S.; Dreinhofer, K. A random-perturbation therapy in chronic non-specific low-back pain patients: A randomised controlled trial. Eur. J. Appl. Physiol. 2017, 117, 2547–2560.
34. Doumas, M.; Rapp, M.A.; Krampe, R.T. Working memory and postural control: Adult age differences in potential for improvement, task priority, and dual tasking. J. Gerontol. Ser. B Psychol. Sci. Soc. Sci. 2009, 64, 193–201.
35. Resch, J.E.; May, B.; Tomporowski, P.D.; Ferrara, M.S. Balance performance with a cognitive task: A continuation of the dual-task testing paradigm. J. Athlethic Train. 2011, 46, 170–175.
36. Lautenbacher, S.; Huber, C.; Schöfer, D.; Kunz, M.; Parthum, A.; Weber, P.G.; Roman, C.; Griessinger, N.; Sittl, R. Attentional and emotional mechanisms related to pain as predictors of chronic postoperative pain: A comparison with other psychological and physiological predictors. Pain 2010, 151, 722–731.
37. Verhoeven, K.; Crombez, G.; Eccleston, C.; Van Ryckeghem, D.M.; Morley, S.; Van Damme, S. The role of motivation in distracting attention away from pain: An experimental study. Pain 2010, 149, 229–234.
38. Villemure, C.; Bushnell, M.C. Mood influences supraspinal pain processing separately from attention. J. Neurosci. 2009, 29, 705–715.
39. Valet, M.; Sprenger, T.; Boecker, H.; Willoch, F.; Rummeny, E.; Conrad, B.; Erhard, P.; Tolle, T.R. Distraction modulates connectivity of the cingulo-frontal cortex and the midbrain during pain—An fMRI analysis. Pain 2004, 109, 399–408.
40. Villarreal, E.A.; Brattico, E.; Vase, L.; Østergaard, L.; Vuust, P. Superior analgesic effect of an active distraction versus pleasant unfamiliar sounds and music: The influence of emotion and cognitive style. PLoS ONE 2012, 7, 1e29397.
41. Tracey, I.; Ploghaus, A.; Gati, J.S.; Clare, S.; Smith, S.; Menon, R.S.; Matthews, P.M. Imaging attentional modulation of pain in the periaqueductal gray in humans. J. Neurosci. 2002, 22, 2748–2752.
42. Pichierri, G.; Wolf, P.; Murer, K.; de Bruin, E.D. Cognitive and cognitive-motor interventions affecting physical functioning: A systematic review. BMC Geriatr. 2011, 11, 29.
43. Niemann, H. California Verbal Learning Test (CVLT)—Deutsche Adaptation; Pearson: London, UK, 2008.
44. Zeidan, F.; Grant, J.A.; Brown, C.A.; McHaffie, J.G.; Coghill, R.C. Mindfulness meditation-related pain relief: Evidence for unique brain mechanisms in the regulation of pain. Neurosci. Lett. 2012, 520, 165–173.
45. Wiebking, C.; Duncan, N.W.; Tiret, B.; Hayes, D.J.; Marjaǹska, M.; Doyon, J.; Bajbouj, M.; Northoff, G. GABA in the insula—A predictor of the neural response to interoceptive awareness. Neuroimage 2014, 86, 10–18.
46. Segal, Z.V.; Teasdale, J.D.; Williams, J.M.G. Mindfulness-Based Cognitive Therapy: Theoretical Rationale and Empirical Status. In Mindfulness and Acceptance: Expanding the Cognitive-Behavioral Tradition; Hayes, S.C., Follette, V.M., Linehan, M.M., Eds.; Guilford Press: New York, NY, USA, 2004; pp. 45–65.
47. Creswell, J.D.; Lindsay, E.K.; Villalba, D.K.; Chin, B. Mindfulness Training and Physical Health. Mechanisms and Outcomes. Psychosom. Med. 2019, 81, 224–232.
48. Grossman, P.; Niemann, L.; Schmidt, S.; Walach, H. Mindfulness-based stress reduction and health benefits-A meta-analysis. J. Psychosom. Res. 2004, 57, 35–44.
49. Taren, A.A.; Gianaros, P.J.; Greco, C.M.; Lindsay, E.K.; Fairgrieve, A.; Brown, K.W.; Rosen, R.K.; Ferris, J.L.; Julson, E.; Marsland, A.L.; et al. Mindfulness Meditation Training and Executive Control Network Resting State Functional Connectivity: A Randomized Controlled Trial. Psychosom. Med. 2018, 79, 674–683.
50. Ditto, B.; Eclache, M.; Goldman, N. Short-term autonomic and cardiovascular effects of mindfulness body scan meditation. Ann. Behav. Med. A Publ. Soc. Behav. Med. 2006, 32, 227–234.
51. Morlion, B.; Coluzzi, F.; Aldington, D.; Kocot-Kepska, M.; Pergolizzi, J.; Mangas, A.C.; Ahlbeck, K.; Kalso, E. Pain chronification: What should a non-pain medicine specialist know? Curr. Med. Res. Opin. 2019, 34, 1169–1178.
52. Carr, D.B. Postmodern pain education “from being to becoming”. Pain 2018, 159, 49–55.
53. Von Korff, M.; Ormel, J.; Keefe, F.J.; Dworkin, S.F. Grading the severity of chronic pain. Pain 1992, 50, 133– 149.
54. Cohen, S.; Kamarck, T.; Mermelstein, R. A global measure of perceived stress. J. Health Soc. Behav. 1983, 24, 385–396.
55. Appels, A.; Hoppener, P.; Mulder, A. A questionnaire to assess premonitory symptoms of myocardial infarction. Int. J. Cardiol. 1987, 17, 15–24.
56. Herrmann-Lingen, C.; Buss, U.; Snaith, R.P. Hospital Anxiety and Depression Scale—Deutsche Version (HADS- D); Verlag Hans Huber: Bern, Switzerland, 1995.
57. Pfingsten, M.; Leibing, E.; Franz, C.; Bansemer, D.; Busch, O.; Hildebrandt, J. Fear-avoidance-beliefs in patients with backpain. Schmerz 1997, 11, 387–395.
58. Kunz, M.; Capito, E.S.; Horn-Hofmann, C.; Baum, C.; Scheel, J.; Karmann, A.J.; Priebe, J.A.; Lautenbacher, S. Psychometric properties of the German version of the Pain Vigilance and Awareness Questionnaire (PVAQ) in pain-free samples and samples with acute and chronic pain. Int. J. Behav. Med. 2017, 24, 260–271.
59. Schwarzer, R.; Schulz, U. Berliner Social-Support Skalen; Freie Universität: Berlin, Germany, 2000.
60. R-Core-Team. R: A Language and Environment for Statistical Computing. R Foundation for Statistical Computing. 2019. Available online: https://www.R-project.org/(accessed on 30 Decemebr 2019).
61. Dworkin, R.H.; Turk, D.C.; Wyrwich, K.W.; Beaton, D.; Cleeland, C.S.; Farrar, J.T.; Haythornthwaite, J.A.; Jensen, M.P.; Kerns, R.D.; Ader, D.N.; et al. Interpreting the Clinical Importance of Treatment Outcomes in Chronic Pain Clinical Trials: IMMPACT Recommendations. J. Pain 2008, 9, 105–121.
62. Goldsmith, E.S.; Taylor, B.C.; Greer, N.; Murdoch, M.; MacDonald, R.; McKenzie, L.; Rosebush, C.E.; Wilt, T.J. Focused Evidence Review: Psychometric Properties of Patient-Reported Outcome Measures for Chronic Musculoskeletal Pain. J. Gen. Intern. Med. 2018, 33, 61–70.
63. Von Korff, M. Assessment of Chronic Pain in Epidemiological and Health Services Research: Empirical Bases and New Directions. In Handbook of Pain Assessment; The Guilford Press: New York, NY, USA, 2011; pp. 455–473.
64. Krebs, E.E.; Bair, M.J.; Damush, T.M.; Tu, W.; Wu, J.; Kroenke, K. Comparative responsiveness of pain outcome measures among primary care patients with musculoskeletal pain. Med care 2010, 48, 1007–1014. doi: 10.1097/MLR.0b013e3181eaf835.
65. Bernard, P.; Romain, A.J.; Caudroit, J.; Chevance, G.; Carayol, M.; Gourlan, M.; Needham Dancause, K.; Moullec, G. Cognitive behavior therapy combined with exercise for adults with chronic diseases: Systematic review and meta-analysis. Health Psychol. 2018, 37, 433–450.
66. Broman-Fulks, J.J.; Abraham, C.M.; Thomas, K.; Canu, W.H.; Nieman, D.C. Anxiety sensitivity mediates the relationship between exercise frequency and anxiety and depression symptomology. Stress Health 2018, 34, 500–508.
67. Smith, B.E.; Hendrick, P.; Bateman, M.; Holden, S.; Littlewood, C.; Smith, T.O.; Logan, P. Musculoskeletal pain and exercise—Challenging existing paradigms and introducing new. Br. J. Sports Med. 2019, 53, 907–912.
68. Wasserstein, R.L.; Schirm, A.L.; Lazar, N.A. Moving to a World Beyond “p < 0.05”. Am. Stat. 2019, 73, 1–19.