MULTIMODAL REHABILITATION TREATMENT OF PATIENTS WITH SCIATICA
Abstract
Pain radiating from the lower back to the lower limb below the knee is known as sciatica. The purpose of this research was to ascertain how patients with sciatica responded to multimodal rehabilitation therapy.
Fifty-one patients with persistent sciatica receiving treatment at the Medical Rehabilitation Clinic of the Clinical Center of Vojvodina were included in the study. In addition to demographic information, we also collected scores from the Oswestry Disability Index, Central Sensitization Inventory, Fear Avoidance Component Scale, and Numerical Rating Scale. At the beginning and completion of the treatment, results were acquired.
Thirty-four out of the patients, or 66.7%, were female. The stationary multimodal treatment for chronic pain took place for a period of 20.48 ± 5.89 days. After the treatment, the NRS assessed pain intensity had significantly decreased (6.49 ± 2.22 vs. 5.00 ± 2.22, t = 5.629, p < 0.001). Following the treatment, there was a substantial improvement in the average ODI score (48.75 ± 15.16 vs. 42.24 ± 14.13 (t = 4.246, p < 0.001) and FACS score (66.80 ± 14.13 vs. 62.47 ± 16.49, t = 2.086, p = 0.042). After the course of the treatment, the CSI score decreased, although this change was not statistically significant (t = 1.446, p = 0.155).
Patients receiving stationary comprehensive rehabilitation treatment see improvements in their functional status, a decrease in their level of fear-induced activity avoidance, and a reduction in the severity of their pain.
References
Beattie P, Maher C. The role of functional status questionnaires for low back pain. Aust J Physiother 1997;43(1):29–38. [CrossRef] [PubMed]
Bevers K, Watts L, Kishino ND, Gatchel RJ. The Biopsychosocial model of the assessment, prevention, and treatment of chronic pain. US Neurol 2016; 12(2):98–104. [CrossRef]
Booth J, Moseley GL, Schiltenwolf M, Cashin A, Davies M, Hübscher M. Exercise for chronic musculoskeletal pain: A biopsychosocial approach. Musculoskeletal Care 2017;15(4):413–21. [CrossRef] [PubMed]
Brooks JM, Iwanaga K, Chiu CY, Cotton BP, Deiches J, Morrison B, et al. Relationships between self-determination theory and theory of planned behavior applied to physical activity and exercise behavior in chronic pain. Psychol Health Med 2017;22(7):814-22. [CrossRef] [PubMed]
Busch H, Bodin L, Bergström G, Jensen IB. Patterns of sickness absence a decade after pain-related multidisciplinary rehabilitation. Pain 2011; 152(8):1727–33. [CrossRef] [PubMed]
Casey MB, Smart K, Segurado R, Hearty C, Gopal H, Lowry D, et al. Exercise combined with Acceptance and Commitment Therapy (ExACT) compared to a supervised exercise programme for adults with chronic pain: Study protocol for a randomised controlled trial. Trials 2018;19(1):1–14. [CrossRef] [PubMed]
Caumo W, Antunes LC, Elkfury JL, Herbstrith EG, Sipmann RB, Souza A, et al. The Central Sensitization Inventory validated and adapted for a Brazilian population: psychometric properties and its relationship with brain-derived neurotrophic factor. J Pain Res [Internet]. 2017 Sep 1 [cited 2023 Jan 12];10:2109. [CrossRef] [PubMed]
Childs JD, Piva SR, Fritz JM. Responsiveness of the numeric pain rating scale in patients with low back pain. Spine (Phila Pa 1976) 2005;30(11):1331–4. [CrossRef] [PubMed]
Coen LJ, Sarno JE. Psychosomatic avoidance of conflict in back pain. J Am Acad Psychoanal 1989;17(3):359–76. [CrossRef] [PubMed]
Cuesta-Vargas AI, Roldan-Jimenez C, Neblett R, Gatchel RJ. Cross-cultural adaptation and validity of the Spanish central sensitization inventory. Springerplus 2016;5(1):1837. [CrossRef] [PubMed]
D BD, C SN, V RP, Ramalingam AT. Content Validity and Test-Retest Reliability of the Gujarati Version of the Central Sensitization Inventory. Natl J Integr Res Med 2016;7(5):18–24.
Dworkin RH, O’Connor AB, Audette J, Baron R, Gourlay GK, Haanpää ML, et al. Recommendations for the pharmacological management of neuropathic pain: an overview and literature update. Mayo Clin Proc 2010;85(3 Suppl):s3-14. [CrossRef] [PubMed]
Fairbank JCT. Letter to the Editor: Oswestry Disability Index. J Neurosurg Spine. 2014;20(2):239–42. [CrossRef] [PubMed]
Fisher K, Johnston M. Validation of the Oswestry low back pain disability questionnaire: Its sensitivity as a measure of change following treatment and its relationship with other aspects of the pain experience. Physiother Theory Pract 1997;13(1):67–80. [CrossRef]
Frymoyer JW. Back pain and sciatica. N Engl J Med 1988;318(5):291–300. [CrossRef] [PubMed]
Galasso A, Urits I, An D, Nguyen D, Borchart M, Yazdi C, et al. A Comprehensive Review of the Treatment and Management of Myofascial Pain Syndrome. Curr Pain Headache Rep 2020;24(8): 43. [CrossRef] [PubMed]
Harper B, Steinbeck L, Aron A. Fascial manipulation vs. standard physical therapy practice for low back pain diagnoses: A pragmatic study. J Bodyw Mov Ther 2019;23(1):115–21. [CrossRef] [PubMed]
Hayden JA, van Tulder MW, Tomlinson G. Systematic review: strategies for using exercise therapy to improve outcomes in chronic low back pain. Ann Intern Med 2005;142(9):776–85. [CrossRef] [PubMed]
Hildebrandt J, Pfingsten M, Saur P, Jansen J. Prediction of success from a multidisciplinary treatment program for chronic low back pain. Spine (Phila Pa 1976) 1997;22(9):990–1001. [CrossRef] [PubMed]
Jensen MP, Turner JA, Romano JM. What is the maximum number of levels needed in pain intensity measurement? Pain 1994;58(3):387–92. [CrossRef] [PubMed]
Jensen RK, Kongsted A, Kjaer P, Koes B. Diagnosis and treatment of sciatica. BMJ 2019; 367. [CrossRef] [PubMed]
Knezevic A, Neblett R, Gatchel RJ, Jeremic-Knezevic M, Bugarski-Ignjatovic V, Tomasevic-Todorovic S, et al. Psychometric validation of the Serbian version of the Fear Avoidance Component Scale (FACS). PLoS One 2018;13(9):e0204311. [CrossRef] [PubMed]
Knezevic A, Neblett R, Jeremic-Knezevic M, Tomasevic-Todorovic S, Boskovic K, Colovic P, et al. Cross-Cultural Adaptation and Psychometric Validation of the Serbian Version of the Central Sensitization Inventory. Pain Pract 2018;18(4):463–72. [CrossRef] [PubMed]
Kregel J, Vuijk PJ, Descheemaeker F, Keizer D, van der Noord R, Nijs J, et al. The Dutch Central Sensitization Inventory (CSI): Factor Analysis, Discriminative Power, and Test-Retest Reliability. Clin J Pain 2016;32(7):624–30. [CrossRef] [PubMed]
Lundberg M, Grimby-Ekman A, Verbunt J, Simmonds MJ. Pain-related fear: a critical review of the related measures. Pain Res Treat 2011;2011:494196.. [CrossRef] [PubMed]
Mcgee SJ, Kaylor BD, Emmott H, Christopher MJ. Defining chronic pain ethics. Pain Med 2011;12(9):1376–84. [CrossRef] [PubMed]
Neblett R, Cohen H, Choi Y, Hartzell MM, Williams M, Mayer TG, et al. The Central Sensitization Inventory (CSI): establishing clinically significant values for identifying central sensitivity syndromes in an outpatient chronic pain sample. J Pain;14(5):438–45. [CrossRef] [PubMed]
O’Connor AB, Dworkin RH. Treatment of neuropathic pain: an overview of recent guidelines. Am J Med 2009;122(10 Suppl):s22-32. [CrossRef] [PubMed]
Ostelo RW. Physiotherapy management of sciatica. J Physiother 2020;66(2):83–8. [CrossRef] [PubMed]
Pfingsten M, Hildebrandt J, Leibing E, Franz C, Saur P. Effectiveness of a multimodal treatment program for chronic low-back pain. Pain 1997;73(1):77–85. [CrossRef] [PubMed]
Pitance L, Piraux E, Lannoy B, Meuus M, Berquin A, Eeckhout C, et al. CROSS CULTURAL ADAPTATION, RELIABILITY AND VALIDITY OF THE FRENCH VERSION OF THE CENTRAL SENSITIZATION INVENTORY. Man Ther 2016;25:83. [CrossRef]
Popović D, Ninić N, Vojnović L, Panić DS, Knežević A. CENTRAL SENSITIZATION INVENTORY SCORES IN PATIENTS WITH NEUROPATHIC PAIN COMPARED TO HEALTHY SUBJECTS. Acta medica medianae. In press 2023.
Porchet F, Wietlisbach V, Burnand B, Daeppen K, Villemure JG, Vader JP, et al. Relationship between severity of lumbar disc disease and disability scores in sciatica patients. Neurosurgery 2002; 50(6):1253–60. [CrossRef] [PubMed]
Rainville J, Hartigan C, Martinez E, Limke J, Jouve C, Finno M. Exercise as a treatment for chronic low back pain. Spine Journal 2004;4(1):106–15. [CrossRef] [PubMed]
Rainville J, Smeets RJEM, Bendix T, Tveito TH, Poiraudeau S, Indahl AJ. Fear-avoidance beliefs and pain avoidance in low back pain--translating research into clinical practice. Spine J 2011;11(9):895–903. [CrossRef] [PubMed]
Roditi D, Robinson ME. The role of psychological interventions in the management of patients with chronic pain. Psychol Res Behav Manag 2011; 4:41-9. [CrossRef] [PubMed]
Ropper AH, Zafonte RD. Sciatica. Longo DL, editor. N Engl J Med 2015; 372(13):1240–8. [CrossRef] [PubMed]
Salduker S, Allers E, Bechan S, Hodgson RE, Meyer F, Meyer H, et al. Practical approach to a patient with chronic pain of uncertain etiology in primary care. J Pain Res 2019;12:2651-62. [CrossRef] [PubMed]
Scascighini L, Toma V, Dober-Spielmann S, Sprott H. Multidisciplinary treatment for chronic pain: a systematic review of interventions and outcomes. Rheumatology (Oxford) 2008;47(5):670–8. [CrossRef] [PubMed]
Scerbo T, Colasurdo J, Dunn S, Unger J, Nijs J, Cook C. Measurement Properties of the Central Sensitization Inventory: A Systematic Review. Pain Pract 2018;18(4):544–54. [CrossRef] [PubMed]
Sherman KJ, Cherkin DC, Erro J, Miglioretti DL, Deyo RA. Comparing yoga, exercise, and a self-care book for chronic low back pain: a randomized, controlled trial. Ann Intern Med 2005;143(12):849–56. [CrossRef] [PubMed]
Steinmetz A, Psczolla M, Seidel W, Niemier K, Derlien S, Nisser J. Effect of subgroup-specific multimodal therapy on chronic spinal back pain and function-a prospective inpatient multicentre clinical trial in Germany. Medicine (Baltimore) 2019;98(1):E13825. [CrossRef] [PubMed]
Tanaka K, Nishigami T, Mibu A, Manfuku M, Yono S, Shinohara Y, et al. Validation of the Japanese version of the Central Sensitization Inventory in patients with musculoskeletal disorders. PLoS One 2017;12(12):e0188719. [CrossRef] [PubMed]
Terminology | International Association for the Study of Pain [Internet]. [cited 2023 Jan 12]. Available from: https://www.iasp-pain.org/resources/terminology/
Tiktinsky R, Chen L, Narayan P. Electrotherapy: yesterday, today and tomorrow. Haemophilia 2010;16(SUPPL. 5):126–31. [CrossRef] [PubMed]
Vlaeyen JWS, Linton SJ. Fear-avoidance and its consequences in chronic musculoskeletal pain: a state of the art. Pain 2000;85(3):317–32. [CrossRef] [PubMed]
Vojnović L, Popović D, Vidić J, Panić DS, Aleksandrić T, Knežević A. GENERALIZED PAIN HYPERSENSITIVITY IN FIBROMYALGIA PATIENTS. Acta medica medianae. In press 2023.
Wertli MM, Rasmussen-Barr E, Held U, Weiser S, Bachmann LM, Brunner F. Fear-avoidance beliefs-a moderator of treatment efficacy in patients with low back pain: a systematic review. Spine J 2014;14(11):2658–78. [CrossRef] [PubMed]
Zale EL, Ditre JW. Pain-Related Fear, Disability, and the Fear-Avoidance Model of Chronic Pain. Curr Opin Psychol 2015; 5:24–30. [CrossRef] [PubMed]
