FAQ: Research Project: GOALS/Metas
- Why study chronic spine pain?
Chronic spine pain is a common and costly health condition for people and society. Neck pain affects 30% to 50% of the general population2 and ranks as the fourth greatest contributor to global disability.3 Low back pain affects up to 80% of people at some point in their lives, 36% of people at any given time, and is ranked the highest contributor to global disability.4 Most people who have an acute episode of spine pain report that their symptoms continue, come back, or get worse up to twelve months later.5, 6 People with chronic spine pain often have trouble finding treatments that help relieve their pain. There is a critical need to identify better strategies to manage pain.
- Why focus on Hispanics/Latinos?
Most existing treatments for chronic spine pain have been developed and tested with Caucasian populations; very few studies have focused on Hispanics/Latinos in the U.S. Hispanics/Latinos also report more frequent and severe episodes of work-related pain than Caucasians.1 Hispanics/Latinos are also more accepting of pain as an inevitable part of life.7 Evidence suggests that healthcare providers are less likely to assess and treat pain in Hispanic/Latino patients compared to other ethnic groups, due in part, to communication barriers and limited access to healthcare resources.8 Hispanics/Latinos also are less likely than African Americans and non-Hispanic Whites to take medicines prescribed by doctors for pain or to seek care from mental health providers for psychological issues that may be related to their chronic pain.8 They also are more likely than other ethnic groups to rely on cultural remedies and religious coping strategies for pain management than seek care from a healthcare professional.8 Taken together, all of these factors suggest a need for more culturally appropriate pain management interventions for Hispanics/Latinos.
- How is the project being conducted?
The researchers are conducting a clinical trial in a Federally Qualified Health Center in San Diego County to determine the effects of a seven-week physical therapy program that involves changing thoughts and behaviors to help with pain management. Patients who are assigned to receive the intervention are provided rehabilitation services including an initial in-person evaluation, telephone visits by a physical therapist, and a mid-treatment in-person session. Patients who are assigned to receive usual care will receive rehabilitation services as they normally would through their healthcare facility. The assessments include online surveys, physical activity monitors, and spine posture and movement sensors.
- How are sensors being used?
Two different types of sensors are used in this project. The first sensor monitors physical activity and sleep during a seven-day monitoring period. Patients are asked to wear this device around their waist during the day, and on their wrist while they sleep. The second sensor measures spine posture and movement. This sensor is placed on the patient’s spine and captures spine posture and movement during an eight-hour monitoring period.
- Why is this type of intervention an effective alternative to traditional medical management of chronic spine pain?
A lack of physical activity and movement during activities of daily living can contribute to chronic pain.9, 10, 11 Changing postures and movements through exercise14 or “movement retraining”12 can improve spine pain and disability. However, many patients suffer from worry and fear13 that a movement will cause them to have more pain. This type of intervention has been shown to reduce the fear of movement and result in more physical activity for those with chronic pain.14, 15, 16 It has been shown to be effective among Caucasian populations with acute post-surgical spine pain;17 however, this is the first research project testing the effectiveness of this type of intervention on Hispanics/Latinos with chronic spine pain.
1 Anderson JT, Hunting KL, Welch LS. Injury and employment patterns among Hispanic construction workers. J Occup Environ Med. 2000;42(2):176-186.
2 Hogg-Johnson S, van der Velde G, Carroll LJ, et al. The burden and determinants of neck pain in the general population: results of the Bone and Joint Decade 2000-2010 Task Force on Neck Pain and Its Associated Disorders. Spine (Phila Pa 1976). 2008;33(4 Suppl):S39-51.
3 Hoy D, March L, Woolf A, et al. The global burden of neck pain: estimates from the global burden of disease 2010 study. Ann Rheum Dis. 2014;73(7):1309-1315.
4 Hoy D, March L, Brooks P, et al. The global burden of low back pain: estimates from the Global Burden of Disease 2010 study. Ann Rheum Dis. 2014;73(6):968-974
5 Cote P, Cassidy JD, Carroll LJ, Kristman V. The annual incidence and course of neck pain in the general population: a population-based cohort study. Pain. 2004;112(3):267-273.
6 da CMCL, Maher CG, Hancock MJ, McAuley JH, Herbert RD, Costa LO. The prognosis of acute and persistent low-back pain: a meta-analysis. CMAJ. 2012;184(11):E613-624.
7 Hollingshead NA, Ashburn-Nardo L, Stewart JC, Hirsh AT. The Pain Experience of Hispanic Americans: A Critical Literature Review and Conceptual Model. J Pain. 2016;17(5):513-528.
8 Green CR, Anderson KO, Baker TA, et al. The unequal burden of pain: confronting racial and ethnic disparities in pain. Pain Med. 2003;4(3):277-294.
9 Saragiotto BT, Maher CG, Yamato TP, et al. Motor control exercise for chronic non-specific low-back pain. Cochrane Database Syst Rev. 2016(1):CD012004.
10 Mueller MJ, Maluf KS. Tissue adaptation to physical stress: a proposed “Physical Stress Theory” to guide physical therapist practice, education, and research. Phys Ther. 2002;82(4):383-403.
11 Van Dillen LR, Sahrmann SA, Norton BJ, Caldwell CA, McDonnell MK, Bloom NJ. Movement system impairment-based categories for low back pain: stage 1 validation. J Orthop Sports Phys Ther. 2003;33(3):126-142.
12 Kent P, Laird R, Haines T. The effect of changing movement and posture using motion-sensor biofeedback, versus guidelines-based care, on the clinical outcomes of people with sub-acute or chronic low back pain-a multicentre, cluster-randomised, placebo-controlled, pilot trial. BMC Musculoskelet Disord. 2015;16:131.
13 Leeuw M, Goossens ME, Linton SJ, Crombez G, Boersma K, Vlaeyen JW. The fear-avoidance model of musculoskeletal pain: current state of scientific evidence. J Behav Med. 2007;30(1):77-94.
14 Turner JA, Mancl L, Aaron LA. Short- and long-term efficacy of brief cognitive-behavioral therapy for patients with chronic temporomandibular disorder pain: a randomized, controlled trial. Pain. 2006;121(3):181-194.
15 Williams AC, McCracken LM. Understanding and Treating Fear of Pain. In: Asmundson GG, Vlaeyen JW, Crombez G, eds: Oxford University Press; 2004:293-312.
16 Woods MP, Asmundson GJ. Evaluating the efficacy of graded in vivo exposure for the treatment of fear in patients with chronic back pain: a randomized controlled clinical trial. Pain. 2008;136(3):271-280.
17 Archer KR, Devin CJ, Vanston SW, et al. Cognitive-Behavioral-Based Physical Therapy for Patients With Chronic Pain Undergoing Lumbar Spine Surgery: A Randomized Controlled Trial. J Pain. 2016;17(1):76-89.