Lumbar spine management chronic pain Flashcards
Acute LBP with Related Cognitive or Affective Tendencies: characteristics
Acute or subacute LBP with related LE pain
Positive depression screen
High score on fear avoidance questionnaire
High score on pain catastrophizing scale
Acute LBP with Related Cognitive or Affective Tendencies: intervention goals
Patient education to address depression, fear avoidance, pain catastrophizing
Chronic LBP with Related Generalized Pain: characteristics
Disorders of the central nervous system specified as central nervous system sensitivity to pain
LBP +/or LE pain longer than 3 months
Generalized pain
Positive depression screen
High score on fear avoidance questionnaire
High score on pain catastrophizing scale= pessimism, helplessness
Chronic LBP with Related Generalized Pain: intervention goals
Patient education to address depression, fear avoidance, pain catastrophizing
Low intensity, prolonged exercise activities
For these CPG categories, the low back pain does not follow the initial, mid-range, or end-range movement/ pain relations reflective of tissue stress, inflammation, and irritability =
Hence, the intervention strategies for these pain categories are not focused on normalizing movement/pain relations but rather on addressing the relevant cognitive and affective tendencies and pain behaviors with patient education and counseling
Acute LBP with Related Cognitive/Affective Tendencies
one or more of the following
- 2 positive responses to primary care eval of mental disorders screens and affect consistent with individual who is depressed
- high scores on fear-avoidance beliefs questionnaire and behavioral processes consistent with individual who has excessive anxiety or fear
- high scores on pain catastrophizing scale and cognitive process consistent with rumination, pessimism, or helpnessess
Acute LBP with Related Cognitive/Affective Tendencies - patient education
patient education and counseling to address specific classification exhibited by the patient
- depression
- fear avoidance
- pain catastrophizing
Chronic LBP with Related Generalized Pain
symptom duration longer than 3 months
one or more of the following
- 2 positive responses to primary care eval of mental disorders screens and affect consistent with individual who is depressed
- high scores on fear-avoidance beliefs questionnaire and behavioral processes consistent with individual who has excessive anxiety or fear
- high scores on pain catastrophizing scale and cognitive process consistent with rumination, pessimism, or helpnessess
Chronic LBP with Related Generalized Pain - patient education
patient education and counseling to address specific classification exhibited by the patient
- depression
- fear avoidance
- pain catastrophizing
low-intensity, prolonged (aerobic) exercise activites
Patient Education Explained: DON’T
Promote extended bed rest
Provide in depth explanations of pathoanatomical reasons of pain
Label your patient
Patient Education Explained: DO
Promote an understanding of the anatomical structure and strength of the human spine
Explain the neuroscience of pain perception
Emphasize the overall favorable prognosis of LBP
Teach active pain coping strategies
Encourage an early return to activity even if still painful
Promote importance of an increased activity level
Clinical Applications – Pacing
Make a plan – write it down
Build up tolerance gradually
Take regular rests between activities
Do small amounts rather that everything at once
Avoid prolonged activity, as well as prolonged rest
Do not rush to increase activity/exercise levels. Just maintaining the program can be beneficial
Slow gradual approach enables long-term change
Clinical Applications – Exercise and Activity mistakes…
no pain; no gain
if it hurts; don’t do it
It does not take much….
Start with 3-5 minutes
50% max heart rate
Add 1-2 minutes every other day
Goal: 30 minutes
PacingWhat are the exceptions??
Long COVID (PASC)
Post-acute sequelae of SARS-CoV-2 infection
myalgic encephalomyelitis
chronic fatigue syndrome
postural orthostatic tachycardic syndrome leading to dysautonomia and post-exertional malaise (PEM)
