The Continuing and Growing Epidemic of Chronic Low Back Pain
Abstract
:1. Introduction
2. The Biopsychosocial Model of Chronic Pain
3. Disease versus Illness
“The distinction between “disease” and “illness” is crucial to understanding chronic pain. Disease is generally defined as an “objective biological event” that involves disruption of specific body structures or organ systems caused by pathological, anatomical, or physiological changes…In contrast to this customary view of physical disease, illness is defined as a “subjective experience or self-attribution” that a disease is present; it yields physical discomfort, emotional distress, behavioral limitations, and psychosocial disruption. In other words, illness refers to how the sick person and members of his or her family and wider social network perceive, live with, and respond to symptoms and disability…The distinction between disease and illness is analogous to the distinction between “pain” and “nociception.” Nociception entails stimulation of nerves that convey information about tissue damage to the brain. Pain is subjective perception that results from the transduction, transmission, and modulation of sensory input filtered through a person’s genetic composition and prior learning history and modulated further by the person’s current physiological status, idiosyncratic appraisals, expectations, current mood state, and sociocultural environment.”(pp. 6–7) [19]
4. Interdisciplinary Pain Management
- The objective quantification of physical/functional deficits (at the beginning, during, and at the end of treatment) in order to tailor/individualize, monitor and guide physical and functional progress and gains. Indeed, one of the most frequent barriers to rehabilitation is physical deconditioning. Such deconditioning occurs when inactivity and disuse of the injured body part culminates in a general loss of function, which becomes progressively worse as the degree of disuse and immobilization increases [30]. The effects of this deconditioning may result in muscle atrophy, the development of stiff/hypomobile joints, loss of endurance and cardiovascular fitness, and an increase in muscle spasms [29].
- Likewise, psychosocial evaluations are conducted to aid in the tailoring of treatment for each patient, as well as to guide and monitor progress and gains.
- These above psychosocial evaluations are used in a multimodal pain and disability program, using cognitive-behavioral therapy (CBT) approaches. As previously reviewed by Gatchel and colleagues [31], CBT is a major component of interdisciplinary treatment: “The central aims of CBT are to identify and replace maladaptive patient cognitions, emotions, and behaviors with more adaptive ones in the hope of maximizing the benefits of other interdisciplinary care components (e.g., physical therapy) and increasing functional capacity through improved coping…CBT has emerged as the psychosocial treatment of choice for chronic pain.” (pp. 124–125) [31].
- Psychopharmacological interventions are also often used for detoxification purposes, as well as for psychosocial management purposes.
- Regular, ongoing interdisciplinary, medically-directed formal team staffings are held at least on a weekly basis, as well as frequent team meetings in order to ensure that patients are progressing, and that any potential barriers to improvement are immediately addressed. This regular communication and feedback among the staff is a requisite element for ensuring successful treatment outcomes.
5. Summary and Conclusions
Conflicts of Interest
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Gatchel, R.J. The Continuing and Growing Epidemic of Chronic Low Back Pain. Healthcare 2015, 3, 838-845. https://doi.org/10.3390/healthcare3030838
Gatchel RJ. The Continuing and Growing Epidemic of Chronic Low Back Pain. Healthcare. 2015; 3(3):838-845. https://doi.org/10.3390/healthcare3030838
Chicago/Turabian StyleGatchel, Robert J. 2015. "The Continuing and Growing Epidemic of Chronic Low Back Pain" Healthcare 3, no. 3: 838-845. https://doi.org/10.3390/healthcare3030838