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 ± 2485 meters before treatment to 3254 ± 3108 m at 12 months (p<0.0001). Diurnal inactivity time decreased from 2.4 ± 1.9 hours before treatment to 1.1 ± 1h at 12 months (p<0.0001). 3.

 

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.