Efficacy of the
one-year management of 46 refractory low back pain patients by a french
multidisciplinary pain center.
Julien Nizard, , Pierre Lombrail, Jean-Michel N’guyen, Gilles Potel,
Youenn Lajat.
MultiDisciplinary
Pain Center, University Hospital, Nantes, France.
Aim of
Investigation:
To describe the characteristics
of a cohort of 46 refractory low back pain patients (regardless of the age), in
the Pain Center of the Nantes University Hospital (France). 2. To use a battery
of recognised indicators to evaluate the efficacy of a one-year management.
Methods:
Inclusion
criteria: chronic low back pain for more than 6 months, refractory to previous
therapies. 2. Patients benefiting from multidisciplinary management taking
occupational aspects into account.
Fourty six
patients (26 women, 20 men, 50.8 ± 13.9 years) with low back pain for 129 +/-
90.6 months were included. Nineteen patients (41%) had undergone spinal
surgery, 5 had been victims of a work accident, 28 (61%) had pain at other
sites. Patients were initially hospitalised 10 days, then had a 3, 6 and 12
months follow-up.
Results:
Pain reduction:
Visual Analogue Scale ratings showed that pain decreased from 7.2 ± 1.5 before
treatment to 4.1 ± 1.9 at 12 months (p<0.0001). 2. Functional improvement:
Visual Scale ratings for functional effects decreased from 7.2 ± 1.3 before
treatment to 4.1 ± 1.9 at 12 months (p<0.0001). Walking capacity improved
from 1664 ±
Twelve patients
used morphine-based drugs before management, only 4 after 12 months. 4. Nine
patients (41%of the 22 workers) returned to work at 12 months. A professional
file was opened for 10 patients, and disability status was recommended for 3
(17%). 5. The evaluation study at 6 months showed a satisfactory general
opinion among patients: 81% were very satisfied or satisfied with the
management, and 93% found pain management very good or good. At the end of follow-up,
only 10 patients had further imaging studies, 11 saw a
specialist outside the initial group, and one underwent spinal surgery.
Conclusions:
1. The study was
preliminary and descriptive, involving 46 patients and without group control.
2. The criteria
for hospitalisation and the nature of multidisciplinary management need to be
defined better, and common judgement criteria for the efficacy of Pain Centres
should be used, including measurement of quality of life and patient
satisfaction.
3. Pain Centres obtained promising results for refractory low back pain,
which were largely valid after 12 months of follow-up.