Back Pain: Santos R

Pincus T, Santos R, Breen A, Burton AK, Underwood M, Anonymous00084. · Royal Holloway, University of London, London, UK. · Arthritis Rheum. · Pubmed #18163411 links to  free full text

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Pincus T, Vogel S, Burton AK, Santos R, Field AP. · Department of Psychology, Royal Holloway, University of London, Egham, UK. · Arthritis Rheum. · Pubmed #17133530 links to  free full text

Abstract: OBJECTIVE: Fear of pain, which is hypothesized to result in avoidance behavior, has been described as an obstacle to recovery in populations of patients with low back pain. However, the evidence to support the link between high levels of fear at early stages of pain and poor prognosis has yet to be systematically assessed. We undertook this review to explore current evidence and to propose further development of theoretical models. METHODS: We performed a systematic literature review of all prospective inception cohorts of patients with acute low back pain that measured fear of pain (often described as fear avoidance) at baseline. RESULTS: We reviewed 9 studies reported between 2001 and 2006. Several of these had acceptable/good methodology. Three studies, of which at least 1 had excellent methodology, showed no link between measures of fear at baseline and poor prognosis in the short term (3 months) or the long term (12 months). Three studies with acceptable methodology showed weak evidence for such a link, but the effect sizes were small. The only study with acceptable methodology to find a clear link suggested that fear of movement was linked to long-term pain. CONCLUSION: Despite the prevalent focus on fear of pain at early stages of back pain, there is little evidence to link such fear states with poor prognosis. There is some evidence to suggest that fear may play a role when pain has become persistent. There is a growing consensus that distress/depression plays an important role at early stages, and clinicians should focus on these factors.

Pincus T, Rusu A, Santos R. · Department of Psychology, Royal Holloway, University of London, Egham, UK. · Clin J Pain. · Pubmed #18496308 No free full text.

Abstract: BACKGROUND: The Depression, Anxiety, and Positive Outlook Scale (DAPOS) was designed to measure mood in pain populations without contamination from somatic items. AIMS: The current study examined responsiveness, internal consistency, and construct validity in pain patients. METHOD: A questionnaire survey before and after a multidisciplinary rehabilitation intervention was completed by chronic pain patients, the majority of whom had back pain. RESULTS: The DAPOS showed excellent internal consistency (N=222, Cronbach alpha=0.86 for the Depression subscale, 0.90 for the Anxiety subscale, and 0.74 for the Positive Outlook subscale) and construct validity (N=82) in comparison with a variety of measures (SF-36; Pain Catastrophizing Scale; Zung Depression). Responsiveness was acceptable (ranging between 0.5 and 0.7, for both the mean change in score after treatment to the variability in patients at baseline, and the standardized response mean), although considerably lower than the Zung Depression Inventory. However, reanalysis without somatic items rendered the responsiveness of the Zung inadequate, indicating that change on this measure was due almost entirely to change in somatic symptoms without change in mood. CONCLUSIONS: Responsiveness of the DAPOS should be reassessed in treatment targeting mood change explicitly. The DAPOS scales show acceptable clinimetric and psychometric properties, and add a measurement of positive outlook to create a more balanced indication of mood in pain patients.

Pincus T, Foster NE, Vogel S, Santos R, Breen A, Underwood M. · Department of Psychology, Royal Holloway University of London, Egham, Surrey, TW20 0EX, UK. · Man Ther. · Pubmed #16914363 No free full text.

Abstract: Chiropractors, osteopaths and physiotherapists play key roles in the management of low back pain (LBP) patients in the UK. We investigated the attitudes of these three professional groups to back pain using a recently developed and validated questionnaire, the Attitudes to Back Pain Scale for musculoskeletal practitioners (ABS-mp). A cross-sectional questionnaire survey was sent to 300 of each professional group (n=900). Responses were analysed from 465 practitioners: 132 chiropractors (28%), 159 osteopaths (34%) and 174 physiotherapists (37%). Overall, all three groups endorse a psychosocial approach to treatment, and see re-activation as a primary goal. However, physiotherapists and osteopaths tend to endorse attitudes towards limiting the number of treatment sessions offered to LBP patients more than chiropractors, and chiropractors endorse a more biomedical approach than physiotherapists. When practice setting (NHS versus private practice) was considered (in physiotherapists alone), physiotherapists working for the NHS endorsed limiting the number of treatment sessions more than those working in the private sector and would also less frequently advise their patients to restrict activities and be vigilant. The results may help explain current clinical practice patterns observed in these groups and their uptake of clinical guideline recommendations.

Pincus T, Vogel S, Santos R, Breen A, Foster N, Underwood M. · Department of Psychology, Royal Holloway, University of London, Egham, Surrey, UK. · Clin J Pain. · Pubmed #16691092 No free full text.

Abstract: OBJECTIVES: Little is known about practitioners' beliefs and attitudes to the treatment of low back pain, and whether these influence their clinical decisions, intervention strategies, and patient-centered outcomes. This study aimed to develop, test, and explore the underlying dimensions of a new questionnaire, the Attitudes to Back Pain Scale (ABS), in a specific group of clinicians, practitioners who specialize in musculoskeletal therapy. METHODS: Items for the draft questionnaire were derived from interviews with practitioners (chiropractors, osteopaths, and physiotherapists). The draft questionnaire (52 items) sought to assess practitioners' attitudes concerning role and self-image plus their beliefs about treatment goals and prognosis of low back pain. The questionnaire was sent to a random selection of 300 practitioners from each professional group, and 546 (61%) responded. Split-sample analyses were performed using exploratory and confirmatory factor analysis. RESULTS: Separate exploratory analyses were done for attitudes concerned with personal interaction (34 items) and attitudes about treatment orientation (18 items), producing six domains: limitations on sessions, psychologic, connection to health care system, confidence and concern, reactivation, and biomedical. Confirmatory analyses indicated that the model tested presented a good fit. Validity interviews revealed high agreement of categorization and low levels of difficulty in categorizing the items. CONCLUSIONS: The internal structure of the new questionnaire not only shows excellent psychometric properties and good face validity, but also has the added advantage of being developed with a specific clinical context in mind. Additional evaluation is required to fully describe the psychometric integrity of this instrument.