Back to Journals » Journal of Pain Research » Volume 10

Looking ahead: chronic spinal pain management

Authors Parkin-Smith GF, Davies SJ, Amorin-Woods LG 

Received 9 March 2017

Accepted for publication 20 July 2017

Published 30 August 2017 Volume 2017:10 Pages 2089—2095

DOI https://doi.org/10.2147/JPR.S136589

Checked for plagiarism Yes

Editor who approved publication: Professor E Alfonso Romero-Sandoval



Gregory F Parkin-Smith,1,2 Stephanie J Davies,3–5 Lyndon G Amorin-Woods2,6


1General Practice, Dunsborough WA, Australia; 2School of Health Professions, Murdoch University, Perth, WA, Australia; 3Private Practice Pain Medicine, Painless Clinic, Perth, WA, Australia; 4School of Medicine and Pharmacology, University of Western Australia, Perth, WA, Australia; 5School of Physiotherapy and Exercise Science, Curtin University, Bentley, WA, Australia; 6Private Chiropractic Practice, Canning Vale, WA, Australia


The other day, we oversaw a seminar on pain management for a local consumer pain group, where all consumers (patients) in attendance were experiencing chronic, persistent spinal pain. Each person had a unique story, and their experience and perceived cause of their pain differed. The quality of life in all these consumers was markedly reduced, which was the only clear similarity, confirming that there may be some similarities in the pain experience, but the pain experience was more often unique and individual. These consumers’ criticisms of care services were consistent, however, with dissatisfaction with their access to care and overall management of their pain. They described variable and often difficult access, limited continuity of care, they were often not taken seriously by health care providers, they received scant information about chronic pain and its prognosis and there were often noteworthy variations in the treatment they received. We agree that these criticisms are commonplace and a frequent gripe directed at health care practitioners about the “system.”1 Moreover, the problems associated with care delivery are confounded by a number of patient/consumer factors, such as lifestyle habits, nutrition, body weight, depression, health literacy, geographical isolation and poor socioeconomic conditions, making the management of persistent pain even more complicated.2 There is no doubt that, in the future, matching the care service and treatment with the individual patient will become an essential component of care services, as has been implied in published research.3–6

 

 

Acknowledgment

Gregory F Parkin-Smith and Stephanie J Davies were formerly the cochairs of Pain Health Working Group (Musculoskeletal Health Network of the WA Department of Health) and both were major contributors to the WA Framework for Persistent Pain.

Disclosure

The authors report no conflicts of interest in this work.

References

1.

Briggs AM, Slater H, Bunzli S, et al. Consumers’ experiences of back pain in rural Western Australia: access to information and services, and self-management behaviours. BMC Health Serv Res. 2012;12(1):357.

2.

Slater H, Briggs AM, Bunzli S, Davies SJ, Smith AJ, Quintner JL. Engaging consumers living in remote areas of Western Australia in the self-management of back pain: a prospective cohort study. BMC Musculoskelet Disord. 2012;13:69.

3.

Foster NE, Hill JC, O’Sullivan P, Hancock M. Stratified models of care. Best practice & research. Clin Rheumatol. 2013;27(5):649–661.

4.

Fritz JM, Cleland JA, Childs JD. Subgrouping patients with low back pain: evolution of a classification approach to physical therapy. J Orthop Sports Phys Ther. 2007;37(6):290–302.

5.

Hill JC, Whitehurst DG, Lewis M, et al. Comparison of stratified primary care management for low back pain with current best practice (STarT Back): a randomised controlled trial. Lancet. 2011;378(9802):1560–1571.

6.

Foster NE, Mullis R, Hill JC, et al. Effect of stratified care for low back pain in family practice (IMPaCT Back): a prospective population-based sequential comparison. Ann Fam Med. 2014;12(2):102–111.

7.

Adams J, Lauche R, Peng W, et al. A workforce survey of Australian chiropractic: the profile and practice features of a nationally representative sample of 2,005 chiropractors. BMC Complement Altern Med. 2017;17(1):14.

8.

Amorin-Woods LG, Parkin-Smith GF, Saboe V, Rosner AL [webpage on the Internet]. Recommendations to the Musculoskeletal Health Network, Health Department of Western Australia related to the Spinal Pain Model of Care made on behalf of the Chiropractors Association of Australia (Western Australian Branch). Top Integr Health Care. 2014;5(2). Available from: http://www.tihcij.com/Articles/Recommendations-to-the-Musculoskeletal-Health-Network-Health-Department-of-Western-Australia-related-to-the-Spinal-Pain-Model-of-Care-made-on-behalf-of-the-Chiropractors-Association-of-Australia-Western-Australian-Branch.aspx?id=0000423. Accessed July 26, 2017.

9.

Cecchi F, Negrini S, Pasquini G, et al. Predictors of functional outcome in patients with chronic low back pain undergoing back school, individual physiotherapy or spinal manipulation. Eur J Phys Rehabil Med. 2012;48(3):371–378.

10.

Deyo RA. The role of spinal manipulation in the treatment of low back pain. JAMA. 2017;317(14):1418–1419.

11.

Paige NM, Miake-Lye IM, Booth M, et al. Association of spinal manipulative therapy with clinical benefit and harm for acute low back pain: systematic review and meta-analysis. JAMA. 2017;317(14):1451–1460.

12.

Garcia AN, Costa LDCM, Hancock M, Costa LOP. Identifying patients with chronic low back pain who respond best to mechanical diagnosis and therapy: secondary analysis of a randomized controlled trial. Phys Ther. 2016;96(5):623–630.

13.

Topp R, Swank AM, Quesada PM, Nyland J, Malkani A. The effect of prehabilitation exercise on strength and functioning after total knee arthroplasty. PM R. 2009;1(8):729–735.

14.

Visser E, Davies S. Expanding Melzack’s pain neuromatrix. The Threat Matrix: a super-system for managing polymodal threats. Pain Pract. 2010;10(2):163.

15.

Visser EJ, Ramachenderan J, Davies SJ, Parsons R. Chronic widespread pain drawn on a body diagram is a screening tool for increased pain sensitization, psycho-social load, and utilization of pain management strategies. Pain Pract. 2016;16(1):31–37.

16.

Grace PM, Hutchinson MR, Maier SF, Watkins LR. Pathological pain and the neuroimmune interface. Nat Rev Immunol. 2014;14(4):217–231.

17.

Keppel Hesselink JM, Kopsky DJ. Palmitoylethanolamide, a nutraceutical, in nerve compression syndromes: efficacy and safety in sciatic pain and carpal tunnel syndrome. J Pain Res. 2015;8:729–734.

18.

Canteri L, Petrosino S, Guida G. Reducción del consumo de antiinflamatorios y analgésicos en el tratamiento del dolor neuropático crónico en pacientes afectados por lumbociatialgia de tipo compresivo y en tratamiento con Normast 300 mg [Reduction in consumption of anti-inflammatory and analgesic medication in the treatment of chronic neuropathic pain in patients affected by compression lumbocischialgia due to the treatment with Normast 300 mg] (Spanish). Dolor. 2010;25(4):227–234.

19.

Vallejo R, Tilley DM, Williams J, Labak S, Aliaga L, Benyamin RM. Pulsed radiofrequency modulates pain regulatory gene expression along the nociceptive pathway. Pain Physician. 2013;16(5):E601–E613.

20.

Yeh CC, Sun HL, Huang CJ, et al. Long-term anti-allodynic effect of immediate pulsed radiofrequency modulation through down-regulation of insulin-like growth factor 2 in a neuropathic pain model. Int J Mol Sci. 2015;16(11):27156–27170.

21.

Wu B, Ni J, Zhang C, Fu P, Yue J, Yang L. Changes in spinal cord met-enkephalin levels and mechanical threshold values of pain after pulsed radio frequency in a spared nerve injury rat model. Neurol Res. 2012;34(4):408–414.

22.

Yeh CC, Wu ZF, Chen JC, et al. Association between extracellular signal-regulated kinase expression and the anti-allodynic effect in rats with spared nerve injury by applying immediate pulsed radiofrequency. BMC Anesthesiol. 2015;15:92.

23.

NHMRC. Evidence-Based Management of Acute Musculoskeletal Pain. 2003. Available from: http://www.nhmrc.gov.au/_files_nhmrc/publications/attachments/cp94.pdf. Accessed May 11, 2015.

24.

Musculoskeletal Health Network. Service Model for Community-Based Musculoskeletal Health in Western Australia. Musculoskeletal Health Network; 2013. Available from: http://www.healthnetworks.health.wa.gov.au/modelsofcare/docs/Service_model_for_community-based_musculoskeletal_health_in_WA.pdf. Accessed November 1, 2016.

25.

Health Networks. Spinal Pain Model of Care. 2009. Available from: http://www.healthnetworks.health.wa.gov.au/modelsofcare/docs/Spinal_Pain_Model_of_Care.pdf. Accessed May 11, 2015.

26.

WA Framework for Persistent Pain 2016–2021: Improving the Health of People with Persistent Pain. 2016. Available from: http://ww2.health.wa.gov.au/Articles/J_M/Musculoskeletal-Health-Network. Accessed March 2, 2017.

27.

Chou R, Deyo R, Friedly J, et al. Nonpharmacologic therapies for low back pain: a systematic review for an American College of Physicians Clinical Practice Guideline. Ann Intern Med. 2017;166(7):493–505.

28.

Chou R, Deyo R, Friedly J, et al. Systemic pharmacologic therapies for low back pain: a systematic review for an American College of Physicians Clinical Practice Guideline. Ann Int Med. 2017;166(7):480–492.

29.

RACGP. The RACGP Curriculum for Australian General Practice 2011: Pain Management. 2011. Available from: http://curriculum.racgp.org.au/media/12341/painmanagement.pdf. Accessed November 1, 2016.

30.

Speerin R, Slater H, Li L, et al. Moving from evidence to practice: models of care for the prevention and management of musculoskeletal conditions. Best Pract Res Clin Rheumatol. 2014;28(3):479–515.

31.

Briggs AM, Towler SC, Speerin R, March LM. Models of care for musculoskeletal health in Australia: now more than ever to drive evidence into health policy and practice. Aust Health Rev. 2014;38(4):401–405.

32.

Amorin-Woods LG, Beck RW, Parkin-Smith GF, Lougheed J, Bremner AP. Adherence to clinical practice guidelines among three primary contact professions: a best evidence synthesis of the literature for the management of acute and subacute low back pain. J Can Chiropr Assoc. 2014;58(3):220–237.

33.

Naccarella L, Greenstock LN, Brooks PM. A framework to support team-based models of primary care within the Australian health care system. MJA Open. 2012;1(suppl 3). Available from: hthttps://www.mja.com.au/system/files/issues/001_03_230712/nac10069_fm.pdf. Accessed November 1, 2016.

34.

Hogg MN, Gibson S, Helou A, DeGabriele J, Farrell MJ. Waiting n pain: a systematic investigation into the provision of persistent pain services in Australia. Med J Aust. 2012;196(6):86–390.

35.

Roxburgh A, Burns L [webpage on the Internet]. Accidental Drug-Induced Deaths Due to Opioids in Australia, 2008. 2012. Available from: http://ndarc.med.unsw.edu.au/resource/accidental-opioid-induced-deaths-australia-2008. Accessed August 20, 2015.

36.

Britt H, Charles J, Henderson J, et al. Table 6.3: Distribution of patient reasons for encounter, by ICPC-2 chapter and most frequent individual reasons for encounter within chapter. General Practice Activity in Australia 2007–08. Sydney: Australian Institute of Health and Welfare; 2008:39–40.

37.

Upshur C, Luckmann R, Savageau J. Primary care provider concerns about management of chronic pain in community clinic populations. J Gen Intern Med. 2006;21:652–655.

38.

Wan A. GP pain management: what are the ‘Ps’ and ‘As’ of pain management? Aust Fam Physician. 2014;43(8):537.

39.

Goucke C. The management of persistent pain. Med J Aust. 2003;178:444–447.

40.

O’Rorke JE, Chen I, Genao I, Panda M, Cykert S. Physicians’ comfort in caring for patients with chronic nonmalignant pain. Am J Med Sci. 2007;333(2):93–100.

41.

Hamilton C. The third way and the end of politics. Draw Board Austr Rev Public Aff. 2001;2(2):90–102.

42.

Bobbio N. Left and Right: The Significance of a Political Distinction/Destra e Sinistra: Ragioni e significati di una distinzione politica. Chicago, Cambridge, United Kingdom: The University of Chicago Press, Chicago, Polity Press; 1997:8.

43.

Thistlethwaite JE. The medical home: a need for collaborative practice. Aust Fam Physician. 2016;45(10):759.

44.

Kellerman R. The patient centred medical home: a new model of practice in the USA. Aust Fam Physician. 2009;38(5):279.

45.

Hepworth J, Marley J. Healthcare teams – a practical framework for integration. Aust Fam Physician. 2010;39(12):969–971.

46.

PHCRIS [webpage on the Internet]. Introduction to Primary Health Networks (PHNs). 2016. Available from: http://www.phcris.org.au/guides/intro_phns.php. Accessed November 1, 2016.

47.

Patient-Centered Primary Care Collaborative (PCPCC) [webpage on the Internet]. 2016. Available from: https://www.pcpcc.org/about. Accessed November 1, 2016.

48.

Higson N. What is and what is not a polyclinic. BMJ. 2008;336(7654):1145.

49.

Kay S. Will polyclinics deliver real benefits for patients? No. BMJ. 2008; 336(7654):1165.

50.

Bonney A, Farmer EA. Health care reform: can we maintain personal continuity? Aust Fam Physician. 2010;39(7):455.

51.

Maeng DD, Graboski A, Allison PL, Fisher DY, Bulger JB. Impact of a value-based insurance design for physical therapy to treat back pain on care utilization and cost. J Pain Res. 2017;10:1337.

Dove Medical Press encourages responsible, free and frank academic debate. The content of the Journal of Pain Research ‘Editorial’ section does not necessarily represent the views of Dove Medical Press, its officers, agents, employees, related entities or the Journal of Pain Research editors. While all reasonable steps have been taken to confirm the content of each Editorial, Dove Medical Press accepts no liability in respect of the content of any Editorial, nor is it responsible for the content and accuracy of any Editorial.

Creative Commons License © 2017 The Author(s). This work is published and licensed by Dove Medical Press Limited. The full terms of this license are available at https://www.dovepress.com/terms.php and incorporate the Creative Commons Attribution - Non Commercial (unported, v3.0) License. By accessing the work you hereby accept the Terms. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed. For permission for commercial use of this work, please see paragraphs 4.2 and 5 of our Terms.