Description): Disability from chronic back pain is a major social and financial burden on American society. Recent trends have focused on treating disability rather than the pain itself, typically known in the literature as """"""""functional restoration."""""""" While there is evidence for the effectiveness of such treatments, others criticize the lack of specificity for specific spinal disorders. For example, many suggest that persons given nonspecific pain diagnoses (e.g., chronic back pain) may actually have specific musculoskeletal dysfunction. Research on the effectiveness of specific interventions for chronic musculoskeletal pain, such as manual therapy, is scant. Also, while it is generally accepted among manual therapists that specific exercises along with manual therapy can decrease future episodes of musculoskeletal dysfunction, there is almost no empirical evidence to support this claim. In this study, the investigators will examine whether chronic pain treatment outcomes can be improved by administering manual therapy and specific adjuvant exercise to patients referred for treatment to a 3-week functional restoration program. As psychosocial factors are increasingly being recognized as having an important impact on disability due to chronic pain, they will also examine how knowledge of pain etiology, dysfunctional attitudes and beliefs about pain, and psychological distress impact pain-related disability and treatment outcome. A two-by-two factorial design (sham therapy vs. manual therapy, specific vs. nonspecific exercise) with random assignment will be employed. One hundred patients (25 in each cell) with chronic pain who are found to have specific musculoskeletal dysfunction(s) will be recruited. Subjects will be treated for 6 sessions over a three-week period, then undergo a three-week functional restoration program, and return for periodic follow-up. Patients and evaluators (but not therapists) will be blind to the patient's treatment condition. The investigators predict that patients who receive manual therapy plus specific adjuvant exercise will demonstrate the best outcomes, and that lack of knowledge regarding diagnosis leads to greater psychological distress and fear of activity, which in turn increases disability and results in poorer treatment outcome.
|Geisser, Michael E; Wiggert, Elizabeth A; Haig, Andrew J et al. (2005) A randomized, controlled trial of manual therapy and specific adjuvant exercise for chronic low back pain. Clin J Pain 21:463-70|
|Geisser, Michael E; Haig, Andrew J; Wallbom, Agnes S et al. (2004) Pain-related fear, lumbar flexion, and dynamic EMG among persons with chronic musculoskeletal low back pain. Clin J Pain 20:61-9|