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Domains of Chronic Low Back Pain and Assessing Treatment Effectiveness: A Clinical Perspective

Artikel i vetenskaplig tidskrift
Författare S. D. Tagliaferri
C. T. Miller
P. J. Owen
U. H. Mitchell
Helena Brisby
B. Fitzgibbon
H. Masse-Alarie
J. Van Oosterwijck
D. L. Belavy
Publicerad i Pain Practice
Volym 20
Nummer/häfte 2
Sidor 211-225
ISSN 1530-7085
Publiceringsår 2020
Publicerad vid Institutionen för kliniska vetenskaper, Avdelningen för ortopedi
Sidor 211-225
Språk en
Länkar dx.doi.org/10.1111/papr.12846
Ämnesord spine, physiotherapy, exercise, manual therapy, physical therapy, fear-avoidance beliefs, sleep quality index, form health survey, musculoskeletal pain, self-efficacy, physical performance, screening, tool, of-life, multidisciplinary rehabilitation, neurophysiology, education, Anesthesiology, Neurosciences & Neurology
Ämneskategorier Neurofysiologi, Neurovetenskaper, Ortopedi


Nonspecific chronic low back pain (CLBP) is a common clinical condition that has impacts at both the individual and societal level. Pain intensity is a primary outcome used in clinical practice to quantify the severity of CLBP and the efficacy of its treatment; however, pain is a subjective experience that is impacted by a multitude of factors. Moreover, differences in effect sizes for pain intensity are not observed between common conservative treatments, such as spinal manipulative therapy, cognitive behavioral therapy, acupuncture, and exercise training. As pain science evolves, the biopsychosocial model is gaining interest in its application for CLBP management. The aim of this article is to discuss our current scientific understanding of pain and present why additional factors should be considered in conservative CLBP management. In addition to pain intensity, we recommend that clinicians should consider assessing the multidimensional nature of CLBP by including physical (disability, muscular strength and endurance, performance in activities of daily living, and body composition), psychological (kinesiophobia, fear-avoidance, pain catastrophizing, pain self-efficacy, depression, anxiety, and sleep quality), social (social functioning and work absenteeism), and health-related quality-of-life measures, depending on what is deemed relevant for each individual. This review also provides practical recommendations to clinicians for the assessment of outcomes beyond pain intensity, including information on how large a change must be for it to be considered "real" in an individual patient. This information can guide treatment selection when working with an individual with CLBP.

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