John O'Dowd - Academia.edu (original) (raw)

Papers by John O'Dowd

Research paper thumbnail of Textbook of spinal surgery. Volumes I and II

The Journal of Bone and Joint Surgery. British volume, 1997

Research paper thumbnail of Long-term results of an intensive cognitive behavioral pain management program for patients with chronic low back pain: a concise report of an extended cohort with a minimum of 5-year follow-up

European Spine Journal, 2019

Purpose Treatment options for chronic low back pain (CLBP) include cognitive behavioral intervent... more Purpose Treatment options for chronic low back pain (CLBP) include cognitive behavioral interventions. Most of these interventions only have small and short-lived effects. Using strict inclusion criteria for participation in an intensive combined physical and psychological program, encouraging effects were reported at 1-year follow-up. This study evaluates the longterm follow-up results of the same program. The hypothesis is that previously reported results are maintained. Methods Structured interviews were conducted in a prospective extended cohort with a minimum of 5-year follow-up in a similar fashion as in the 1-year follow-up report. The median follow-up in this cohort was 6.5 years. The extended cohort consisted of 277 patients (85% response). Results Outcomes include daily functioning, quality of life, current pain intensity, pain disturbance in daily activities and indicators of the use of pain medication and healthcare services. The previously reported positive 1-year follow-up results were maintained at a minimum of 5-year follow-up. Disability as measured with the Oswestry disability index (ODIv2.1a) decreased from 40 to 27 in the first year. This positive result was maintained at the 6.5-year follow-up with an ODI of 28. Pain intensity (NRS 0-100) improved from 60 to 39 in the first year, and at 6.5 years, this had further improved to 33. Improvement in quality of life (SF 36) at 1-year follow-up was maintained at 6.5-year follow-up, and healthcare consumption had decreased substantially as measured with doctor visits and analgesics used for CLBP. Conclusion Selected and motivated patients with longstanding CLBP improve fast after an intensive combined physical and psychological program in daily functioning, pain and quality of life. Positive 1-year results are maintained, and healthcare utilization was still reduced at a minimum of 5-year follow-up.

Research paper thumbnail of Horizontal gaze palsy and scoliosis: a case report and review of the literature

Hippokratia, 2013

The syndrome of horizontal gaze palsy with progressive scoliosis (HGPPS) is a rare human disease ... more The syndrome of horizontal gaze palsy with progressive scoliosis (HGPPS) is a rare human disease and while its association with scoliosis was first reported in 1974, thirty years later the responsible genetic mutations are being elucidated. This progress was due to the reporting of single interesting cases. We present the case of a 27 year-old male patient who was admitted for elective scoliosis correction surgery and who represented after an uncomplicated discharge with headache and vomiting; because of a gaze palsy he underwent brain imaging that confirmed a brainstem abnormality, consistent with the syndrome of horizontal gaze palsy with progressive scoliosis (HGPPS), a rare autosomal recessive human disease. This rare syndrome is a good example of how single case reports can lead to advances in laboratory research and genetic characterisation of diseases, together with implications for neurodevelopment. Vigilance in the neurological examination in an otherwise 'non-neurologi...

Research paper thumbnail of Assessing long term backache after childbirth

BMJ, 1993

and suggests that antenatal testing could prevent a significant proportion ofvertical infection. ... more and suggests that antenatal testing could prevent a significant proportion ofvertical infection. In a recent survey of all obstetric units in the British Isles, 51% were offering HIV tests only to women perceived as being at risk, 3% to all women, and the remainder had no formal policy.3 Our results show that in south east England, only 17% of live births to infected women are recognised before delivery. There is therefore considerable scope for improvement in antenatal HIV testing programmes. We thank the obstetricians, midwives, paediatricians, and other physicians who have participated in the reporting schemes, microbiologists reporting HIV seropositive children to CDSC and CD(S), and T Berry for her clerical help. This study is supported by the AIDS Education and Research Trust (AVERT). The unlinked anonymous testing programme is supported by the Medical Research Council. The British Paediatric Surveillance Unit is supported by the Medical Research Fund of Children Nationwide.

Research paper thumbnail of Do first impressions count?

European Spine Journal, 1998

Psychologic factors may have a major influence on the outcome of treatment for back pain. Psychol... more Psychologic factors may have a major influence on the outcome of treatment for back pain. Psychologic disturbance is manifest as emotional distress and may be associated with inappropriate symptoms and signs. Few outcome studies

Research paper thumbnail of Osteoblastoma of the vertebral body of the third lumbar vertebra

European Spine Journal, 1998

Research paper thumbnail of Activation of WNT and BMP signaling in adult human articular cartilage following mechanical injury

Arthritis research & therapy, 2006

Acute full thickness joint surface defects can undergo repair, which involves tissue patterning a... more Acute full thickness joint surface defects can undergo repair, which involves tissue patterning and endochondral bone formation. Molecular signals regulating this process may contribute to the repair outcome, chronic evolution and, eventually, the onset of osteoarthritis. We tested the hypothesis that mechanical injury modulates morphogenetic pathways in adult human articular cartilage explants. Adjacent articular cartilage explants were obtained from preserved areas of the femoral condyles of patients undergoing arthroplasty for osteoarthritis, or from a normal joint of a patient undergoing lower limb amputation. Paired explants were individually maintained in explant culture. From each pair, one explant was mechanically injured and the other left uninjured as a control. Cultures were terminated at different time points for histochemistry, immunohistochemistry and gene expression analysis by reverse transcription real time PCR. Bone morphogenetic protein 2 (BMP-2) mRNA was upregula...

Research paper thumbnail of Daily functioning and self-management in patients with chronic low back pain after an intensive cognitive behavioral programme for pain management

European Spine Journal, 2010

Chronic low back pain (CLBP) is associated with persistent or recurrent disability which results ... more Chronic low back pain (CLBP) is associated with persistent or recurrent disability which results in high costs for society. Cognitive behavioral treatments produce clinically relevant benefits for patients with CLBP. Nevertheless, no clear evidence for the most appropriate intervention is yet available. The purpose of this study is to evaluate the mid-term effects of treatment in a cohort of patients with CLBP participating in an intensive pain management programme. The programme provided by RealHealth-Netherlands is based on cognitive behavioral principles and executed in collaboration with orthopedic surgeons. Main outcome parameters were daily functioning (Roland and Morris Disability Questionnaire and Oswestry Disability Questionnaire), self-efficacy (Pain Self-Efficacy Questionnaire) and quality of life (Short Form 36 Physical Component Score). All parameters were measured at baseline, last day of residential programme and at 1 and 12 months follow-up. Repeated measures analysis was applied to examine changes over time. Clinical relevance was examined using minimal clinical important differences (MCID) estimates for main outcomes. To compare results with literature effect sizes (Cohen's d) and Standardized Morbidity Ratios (SMR) were determined. 107 patients with CLBP participated in this programme. Mean scores on outcome measures showed a similar pattern: improvement after residential programme and maintenance of results over time. Effect sizes were 0.9 for functioning, 0.8 for self-efficacy and 1.3 for physical functioning related quality of life. Clinical relevancy: 79% reached MCID on functioning, 53% on self-efficacy and 80% on quality of life. Study results on functioning were found to be 36% better and 2% worse when related to previous research on, respectively, rehabilitation programmes and spinal surgery for similar conditions (SMR 136 and 98%, respectively). The participants of this evidence-based programme learned to manage CLBP, improved in daily functioning and quality of life. The study results are meaningful and comparable with results of spinal surgery and even better than results from less intensive rehabilitation programmes. Keywords Chronic low back pain Á Disability Á Self-management Á Cognitive behavioral programme Á Cohort study Á Clinical relevance

Research paper thumbnail of Predictive factors for successful clinical outcome 1 year after an intensive combined physical and psychological programme for chronic low back pain

European Spine Journal, 2013

The aim of this longitudinal study is to determine the factors which predict a successful 1-year ... more The aim of this longitudinal study is to determine the factors which predict a successful 1-year outcome from an intensive combined physical and psychological (CPP) programme in chronic low back pain (CLBP) patients. Methods A prospective cohort of 524 selected consecutive CLBP patients was followed. Potential predictive factors included demographic characteristics, disability, pain and cognitive behavioural factors as measured at pretreatment assessment. The primary outcome measure was the oswestry disability index (ODI). A successful 1-year follow-up outcome was defined as a functional status equivalent to 'normal' and healthy populations (ODI B22). The 2-week residential programme fulfills the recommendations in international guidelines. For statistical analysis we divided the database into two equal samples. A random sample was used to develop a prediction model with multivariate logistic regression. The remaining cases were used to validate this model. Results The final predictive model suggested being 'in employment' at pre-treatment [OR 3.61 (95 % CI 1.80-7.26)] and an initial 'disability score' [OR 0.94 (95 % CI 0.92-0.97)] as significant predictive factors for a successful 1-year outcome (R 2 = 22 %; 67 % correctly classified). There was no predictive value from measures of psychological distress. Conclusion CLBP patients who are in work and mild to moderately disabled at the start of a CPP programme are most likely to benefit from it and to have a successful treatment outcome. In these patients, the disability score falls to values seen in healthy populations. This small set of factors is easily identified, allowing selection for programme entry and triage to alternative treatment regimes.

Research paper thumbnail of Spinal instrumentation

The Journal of Bone and Joint Surgery. British volume, 2000

Research paper thumbnail of Psychosocial Factors in Low Back Related Conditions

Spine Surgery Education Programme

Research paper thumbnail of What is the Mean Mortality Time in Patients Considered Suitable for Vertebroplasty?

Research paper thumbnail of Avoiding litigation in spine surgery—are we saving the level check?

Research paper thumbnail of Long-term follow-up Results of a Combined Physical and Psychological Program for Patients with Chronic Low Back Pain

Global Spine Journal, 2016

Research paper thumbnail of Herniated lumbar disc

BMJ clinical evidence, Jan 26, 2009

Herniated lumbar disc is a displacement of disc material (nucleus pulposus or annulus fibrosis) b... more Herniated lumbar disc is a displacement of disc material (nucleus pulposus or annulus fibrosis) beyond the intervertebral disc space. The highest prevalence is among people aged 30-50 years, with a male to female ratio of 2:1. There is little evidence to suggest that drug treatments are effective in treating herniated disc. We conducted a systematic review and aimed to answer the following clinical questions: What are the effects of drug treatments, non-drug treatments, and surgery for herniated lumbar disc? We searched: Medline, Embase, The Cochrane Library, and other important databases up to July 2008 (Clinical Evidence reviews are updated periodically; please check our website for the most up-to-date version of this review). We included harms alerts from relevant organisations such as the US Food and Drug Administration (FDA) and the UK Medicines and Healthcare products Regulatory Agency (MHRA). We found 49 systematic reviews, RCTs, or observational studies that met our inclusio...

Research paper thumbnail of Lumbosacral fusion study

http://isrctn.org/>, 2000

Research paper thumbnail of Antibiotics a cure for back pain, a false dawn or a new era?

European Spine Journal, 2013

Research paper thumbnail of A short, intensive cognitive behavioral pain management program reduces health-care use in patients with chronic low back pain

European Spine Journal, 2012

Purpose Cognitive behavioral interventions are recommended as non-invasive treatment options for ... more Purpose Cognitive behavioral interventions are recommended as non-invasive treatment options for patients with chronic low back pain (CLBP). However, most treatment effects are small and short-lived. Although a 2-week intensive pain management program for patients with CLBP seems to be effective, the long-term results are not known. The purpose of this study is to evaluate the stability of the 2-year follow-up results and whether this is reflected in the use of health-care services. Methods A prospective cohort study was performed. Pretreatment characteristics of patients and data of outcomes obtained at 1-year follow-up were used. At 2-year followup a structured interview was conducted following the principles of a post-marketing survey. Outcomes included daily functioning, quality of life, current intensity of pain, disturbance of pain during daily activities, and indicators of the use of pain medication and health-care services. Results Of the 90 eligible patients 85 (94%) participated in the post-marketing survey. The 1-year clinical relevant effects are maintained at 2-year follow-up. Effect sizes for functioning and quality of life were large. More than 65% reached preset minimal clinically important differences. At pre-treatment all patients consulted their general practitioner (GP) and medical specialist (MS). At 2-year followup 73% reported having consulted neither a GP nor an MS during the previous year. Most of the patients indicated not to use any pain medication (57%) and the percentage patients using opioids have decreased (14%). Moreover, 81% reported to be at work. Conclusions The gained results from selected and motivated patients with longstanding CLBP at 1-year follow-up are stable at 2-year follow-up. Above all, most of the participants are at work and results indicate that the use of both pain medication and health care have decreased substantially. Keywords Chronic low back pain Á Health-care services Á Cognitive behavioral program Á Pain management Á Daily functioning

Research paper thumbnail of Introducing the Society for Back Pain Research

European Spine Journal, 2012

Research paper thumbnail of S651 Positive Results of a Short Pain Management Program for Functioning and Healthcare Use in Patients with Chronic Low Back Pain

European Journal of Pain Supplements, 2011

Background and Aims: Improved function is a pain management outcome but suffers from a lack of si... more Background and Aims: Improved function is a pain management outcome but suffers from a lack of simple quick tests. Data on multidisciplinary clinics (MDC) and functional goals are limited. This study evaluates the use of the 6-minute walk test (6MWT) in a heterogeneous group of chronic pain patients. Methods: This chart review was approved by the Clinic Ethics Board. This study used the 6MWT in determining functional improvement over time in 37 patients evaluated upon entering the MDC, and again 3-6 months later. During this time, patients were exposed to a full range of possible MDC therapeutic modalities. As this was a chart review study, interventions followed a typical course and were driven by clinical presentation and judgment of the managing physician. Results: At pre-evaluation, patients were able to walk an average of 274.05 yards. At follow-up, mean walk distances had improved to 349.46 yards, which represented a significant improvement (t 1,36 = 17.08, p < 0.0001). Conclusions: Thus, there is evidence that MDC services can have an impact on functionality and that the 6MWT may be a suitable addition to assessing pain patients. Improved function is an important goal in pain patients, especially those on opioids and the 6MWT show promise for assessment, although it is not validated in chronic pain, except in fibromyalgia patients. This study is ongoing, prospective and now part of the clinical evaluation of all patients entering the MDC. We plan on validating the 6MWT in the chronic pain population.

Research paper thumbnail of Textbook of spinal surgery. Volumes I and II

The Journal of Bone and Joint Surgery. British volume, 1997

Research paper thumbnail of Long-term results of an intensive cognitive behavioral pain management program for patients with chronic low back pain: a concise report of an extended cohort with a minimum of 5-year follow-up

European Spine Journal, 2019

Purpose Treatment options for chronic low back pain (CLBP) include cognitive behavioral intervent... more Purpose Treatment options for chronic low back pain (CLBP) include cognitive behavioral interventions. Most of these interventions only have small and short-lived effects. Using strict inclusion criteria for participation in an intensive combined physical and psychological program, encouraging effects were reported at 1-year follow-up. This study evaluates the longterm follow-up results of the same program. The hypothesis is that previously reported results are maintained. Methods Structured interviews were conducted in a prospective extended cohort with a minimum of 5-year follow-up in a similar fashion as in the 1-year follow-up report. The median follow-up in this cohort was 6.5 years. The extended cohort consisted of 277 patients (85% response). Results Outcomes include daily functioning, quality of life, current pain intensity, pain disturbance in daily activities and indicators of the use of pain medication and healthcare services. The previously reported positive 1-year follow-up results were maintained at a minimum of 5-year follow-up. Disability as measured with the Oswestry disability index (ODIv2.1a) decreased from 40 to 27 in the first year. This positive result was maintained at the 6.5-year follow-up with an ODI of 28. Pain intensity (NRS 0-100) improved from 60 to 39 in the first year, and at 6.5 years, this had further improved to 33. Improvement in quality of life (SF 36) at 1-year follow-up was maintained at 6.5-year follow-up, and healthcare consumption had decreased substantially as measured with doctor visits and analgesics used for CLBP. Conclusion Selected and motivated patients with longstanding CLBP improve fast after an intensive combined physical and psychological program in daily functioning, pain and quality of life. Positive 1-year results are maintained, and healthcare utilization was still reduced at a minimum of 5-year follow-up.

Research paper thumbnail of Horizontal gaze palsy and scoliosis: a case report and review of the literature

Hippokratia, 2013

The syndrome of horizontal gaze palsy with progressive scoliosis (HGPPS) is a rare human disease ... more The syndrome of horizontal gaze palsy with progressive scoliosis (HGPPS) is a rare human disease and while its association with scoliosis was first reported in 1974, thirty years later the responsible genetic mutations are being elucidated. This progress was due to the reporting of single interesting cases. We present the case of a 27 year-old male patient who was admitted for elective scoliosis correction surgery and who represented after an uncomplicated discharge with headache and vomiting; because of a gaze palsy he underwent brain imaging that confirmed a brainstem abnormality, consistent with the syndrome of horizontal gaze palsy with progressive scoliosis (HGPPS), a rare autosomal recessive human disease. This rare syndrome is a good example of how single case reports can lead to advances in laboratory research and genetic characterisation of diseases, together with implications for neurodevelopment. Vigilance in the neurological examination in an otherwise 'non-neurologi...

Research paper thumbnail of Assessing long term backache after childbirth

BMJ, 1993

and suggests that antenatal testing could prevent a significant proportion ofvertical infection. ... more and suggests that antenatal testing could prevent a significant proportion ofvertical infection. In a recent survey of all obstetric units in the British Isles, 51% were offering HIV tests only to women perceived as being at risk, 3% to all women, and the remainder had no formal policy.3 Our results show that in south east England, only 17% of live births to infected women are recognised before delivery. There is therefore considerable scope for improvement in antenatal HIV testing programmes. We thank the obstetricians, midwives, paediatricians, and other physicians who have participated in the reporting schemes, microbiologists reporting HIV seropositive children to CDSC and CD(S), and T Berry for her clerical help. This study is supported by the AIDS Education and Research Trust (AVERT). The unlinked anonymous testing programme is supported by the Medical Research Council. The British Paediatric Surveillance Unit is supported by the Medical Research Fund of Children Nationwide.

Research paper thumbnail of Do first impressions count?

European Spine Journal, 1998

Psychologic factors may have a major influence on the outcome of treatment for back pain. Psychol... more Psychologic factors may have a major influence on the outcome of treatment for back pain. Psychologic disturbance is manifest as emotional distress and may be associated with inappropriate symptoms and signs. Few outcome studies

Research paper thumbnail of Osteoblastoma of the vertebral body of the third lumbar vertebra

European Spine Journal, 1998

Research paper thumbnail of Activation of WNT and BMP signaling in adult human articular cartilage following mechanical injury

Arthritis research & therapy, 2006

Acute full thickness joint surface defects can undergo repair, which involves tissue patterning a... more Acute full thickness joint surface defects can undergo repair, which involves tissue patterning and endochondral bone formation. Molecular signals regulating this process may contribute to the repair outcome, chronic evolution and, eventually, the onset of osteoarthritis. We tested the hypothesis that mechanical injury modulates morphogenetic pathways in adult human articular cartilage explants. Adjacent articular cartilage explants were obtained from preserved areas of the femoral condyles of patients undergoing arthroplasty for osteoarthritis, or from a normal joint of a patient undergoing lower limb amputation. Paired explants were individually maintained in explant culture. From each pair, one explant was mechanically injured and the other left uninjured as a control. Cultures were terminated at different time points for histochemistry, immunohistochemistry and gene expression analysis by reverse transcription real time PCR. Bone morphogenetic protein 2 (BMP-2) mRNA was upregula...

Research paper thumbnail of Daily functioning and self-management in patients with chronic low back pain after an intensive cognitive behavioral programme for pain management

European Spine Journal, 2010

Chronic low back pain (CLBP) is associated with persistent or recurrent disability which results ... more Chronic low back pain (CLBP) is associated with persistent or recurrent disability which results in high costs for society. Cognitive behavioral treatments produce clinically relevant benefits for patients with CLBP. Nevertheless, no clear evidence for the most appropriate intervention is yet available. The purpose of this study is to evaluate the mid-term effects of treatment in a cohort of patients with CLBP participating in an intensive pain management programme. The programme provided by RealHealth-Netherlands is based on cognitive behavioral principles and executed in collaboration with orthopedic surgeons. Main outcome parameters were daily functioning (Roland and Morris Disability Questionnaire and Oswestry Disability Questionnaire), self-efficacy (Pain Self-Efficacy Questionnaire) and quality of life (Short Form 36 Physical Component Score). All parameters were measured at baseline, last day of residential programme and at 1 and 12 months follow-up. Repeated measures analysis was applied to examine changes over time. Clinical relevance was examined using minimal clinical important differences (MCID) estimates for main outcomes. To compare results with literature effect sizes (Cohen's d) and Standardized Morbidity Ratios (SMR) were determined. 107 patients with CLBP participated in this programme. Mean scores on outcome measures showed a similar pattern: improvement after residential programme and maintenance of results over time. Effect sizes were 0.9 for functioning, 0.8 for self-efficacy and 1.3 for physical functioning related quality of life. Clinical relevancy: 79% reached MCID on functioning, 53% on self-efficacy and 80% on quality of life. Study results on functioning were found to be 36% better and 2% worse when related to previous research on, respectively, rehabilitation programmes and spinal surgery for similar conditions (SMR 136 and 98%, respectively). The participants of this evidence-based programme learned to manage CLBP, improved in daily functioning and quality of life. The study results are meaningful and comparable with results of spinal surgery and even better than results from less intensive rehabilitation programmes. Keywords Chronic low back pain Á Disability Á Self-management Á Cognitive behavioral programme Á Cohort study Á Clinical relevance

Research paper thumbnail of Predictive factors for successful clinical outcome 1 year after an intensive combined physical and psychological programme for chronic low back pain

European Spine Journal, 2013

The aim of this longitudinal study is to determine the factors which predict a successful 1-year ... more The aim of this longitudinal study is to determine the factors which predict a successful 1-year outcome from an intensive combined physical and psychological (CPP) programme in chronic low back pain (CLBP) patients. Methods A prospective cohort of 524 selected consecutive CLBP patients was followed. Potential predictive factors included demographic characteristics, disability, pain and cognitive behavioural factors as measured at pretreatment assessment. The primary outcome measure was the oswestry disability index (ODI). A successful 1-year follow-up outcome was defined as a functional status equivalent to 'normal' and healthy populations (ODI B22). The 2-week residential programme fulfills the recommendations in international guidelines. For statistical analysis we divided the database into two equal samples. A random sample was used to develop a prediction model with multivariate logistic regression. The remaining cases were used to validate this model. Results The final predictive model suggested being 'in employment' at pre-treatment [OR 3.61 (95 % CI 1.80-7.26)] and an initial 'disability score' [OR 0.94 (95 % CI 0.92-0.97)] as significant predictive factors for a successful 1-year outcome (R 2 = 22 %; 67 % correctly classified). There was no predictive value from measures of psychological distress. Conclusion CLBP patients who are in work and mild to moderately disabled at the start of a CPP programme are most likely to benefit from it and to have a successful treatment outcome. In these patients, the disability score falls to values seen in healthy populations. This small set of factors is easily identified, allowing selection for programme entry and triage to alternative treatment regimes.

Research paper thumbnail of Spinal instrumentation

The Journal of Bone and Joint Surgery. British volume, 2000

Research paper thumbnail of Psychosocial Factors in Low Back Related Conditions

Spine Surgery Education Programme

Research paper thumbnail of What is the Mean Mortality Time in Patients Considered Suitable for Vertebroplasty?

Research paper thumbnail of Avoiding litigation in spine surgery—are we saving the level check?

Research paper thumbnail of Long-term follow-up Results of a Combined Physical and Psychological Program for Patients with Chronic Low Back Pain

Global Spine Journal, 2016

Research paper thumbnail of Herniated lumbar disc

BMJ clinical evidence, Jan 26, 2009

Herniated lumbar disc is a displacement of disc material (nucleus pulposus or annulus fibrosis) b... more Herniated lumbar disc is a displacement of disc material (nucleus pulposus or annulus fibrosis) beyond the intervertebral disc space. The highest prevalence is among people aged 30-50 years, with a male to female ratio of 2:1. There is little evidence to suggest that drug treatments are effective in treating herniated disc. We conducted a systematic review and aimed to answer the following clinical questions: What are the effects of drug treatments, non-drug treatments, and surgery for herniated lumbar disc? We searched: Medline, Embase, The Cochrane Library, and other important databases up to July 2008 (Clinical Evidence reviews are updated periodically; please check our website for the most up-to-date version of this review). We included harms alerts from relevant organisations such as the US Food and Drug Administration (FDA) and the UK Medicines and Healthcare products Regulatory Agency (MHRA). We found 49 systematic reviews, RCTs, or observational studies that met our inclusio...

Research paper thumbnail of Lumbosacral fusion study

http://isrctn.org/>, 2000

Research paper thumbnail of Antibiotics a cure for back pain, a false dawn or a new era?

European Spine Journal, 2013

Research paper thumbnail of A short, intensive cognitive behavioral pain management program reduces health-care use in patients with chronic low back pain

European Spine Journal, 2012

Purpose Cognitive behavioral interventions are recommended as non-invasive treatment options for ... more Purpose Cognitive behavioral interventions are recommended as non-invasive treatment options for patients with chronic low back pain (CLBP). However, most treatment effects are small and short-lived. Although a 2-week intensive pain management program for patients with CLBP seems to be effective, the long-term results are not known. The purpose of this study is to evaluate the stability of the 2-year follow-up results and whether this is reflected in the use of health-care services. Methods A prospective cohort study was performed. Pretreatment characteristics of patients and data of outcomes obtained at 1-year follow-up were used. At 2-year followup a structured interview was conducted following the principles of a post-marketing survey. Outcomes included daily functioning, quality of life, current intensity of pain, disturbance of pain during daily activities, and indicators of the use of pain medication and health-care services. Results Of the 90 eligible patients 85 (94%) participated in the post-marketing survey. The 1-year clinical relevant effects are maintained at 2-year follow-up. Effect sizes for functioning and quality of life were large. More than 65% reached preset minimal clinically important differences. At pre-treatment all patients consulted their general practitioner (GP) and medical specialist (MS). At 2-year followup 73% reported having consulted neither a GP nor an MS during the previous year. Most of the patients indicated not to use any pain medication (57%) and the percentage patients using opioids have decreased (14%). Moreover, 81% reported to be at work. Conclusions The gained results from selected and motivated patients with longstanding CLBP at 1-year follow-up are stable at 2-year follow-up. Above all, most of the participants are at work and results indicate that the use of both pain medication and health care have decreased substantially. Keywords Chronic low back pain Á Health-care services Á Cognitive behavioral program Á Pain management Á Daily functioning

Research paper thumbnail of Introducing the Society for Back Pain Research

European Spine Journal, 2012

Research paper thumbnail of S651 Positive Results of a Short Pain Management Program for Functioning and Healthcare Use in Patients with Chronic Low Back Pain

European Journal of Pain Supplements, 2011

Background and Aims: Improved function is a pain management outcome but suffers from a lack of si... more Background and Aims: Improved function is a pain management outcome but suffers from a lack of simple quick tests. Data on multidisciplinary clinics (MDC) and functional goals are limited. This study evaluates the use of the 6-minute walk test (6MWT) in a heterogeneous group of chronic pain patients. Methods: This chart review was approved by the Clinic Ethics Board. This study used the 6MWT in determining functional improvement over time in 37 patients evaluated upon entering the MDC, and again 3-6 months later. During this time, patients were exposed to a full range of possible MDC therapeutic modalities. As this was a chart review study, interventions followed a typical course and were driven by clinical presentation and judgment of the managing physician. Results: At pre-evaluation, patients were able to walk an average of 274.05 yards. At follow-up, mean walk distances had improved to 349.46 yards, which represented a significant improvement (t 1,36 = 17.08, p < 0.0001). Conclusions: Thus, there is evidence that MDC services can have an impact on functionality and that the 6MWT may be a suitable addition to assessing pain patients. Improved function is an important goal in pain patients, especially those on opioids and the 6MWT show promise for assessment, although it is not validated in chronic pain, except in fibromyalgia patients. This study is ongoing, prospective and now part of the clinical evaluation of all patients entering the MDC. We plan on validating the 6MWT in the chronic pain population.