Abstract
ABSTRACTBackgroundLongitudinal studies have shown that the symptoms of chronic low back pain (CLBP) will follow an episodic trajectory characterized by periods of high and low pain intensity that can persist for many years. There is a growing belief that the contemporary approach of limiting physical therapy to short, but intense courses of treatment for (CLBP) may be sub-optimal because these limited “windows” of clinical care are not congruent with the natural history of this condition. Recent research has suggested that people with CLBP undergo substantial, and individualized long-term variations in the neural processing of nociception over time. This has led to the concept of a “unique biosignature of pain” that may explain much of the variation in a person’s clinical picture. These and other findings have led to the reconceptualization of CLBP as an individualized, and continually evolving condition that may be more suitably managed by empowering the patient toward self-management strategies that can be modified as needed over time by the PT.ObjectivesThe purpose of this Master Class Paper is to describe an emerging approach for the treatment of CLBP that emphasizes the formation of a long-term therapeutic alliance between the patient and the PT with an emphasis on individualized, patient-preferred approaches for activity-based self-management as an alternative to the contemporary approach of short, intense episodes of care directed toward pain reduction.ConclusionLongitudinal care using assisted self-management strategies is more congruent with the natural history of CLBP than are traditional approaches for PT intervention. This approach may empower patients to undergo lifestyle changes that will favorably influence long-term outcomes; however additional research is needed.
Highlights
ABSTRACT | Background: Longitudinal studies have shown that the symptoms of chronic low back pain (CLBP) will follow an episodic trajectory characterized by periods of high and low pain intensity that can persist for many years
One under‐investigated possibility is that the traditional approach of utilizing physical therapy (PT) for a short, but intense course of treatment such as the common approach of 12 visits over a 4-8 week period[18] may be sub-optimal because this does not typically generate the dosage and duration needed to favorably influence tissue changes and promote the behavioral modifications needed to maximize the likelihood of success[6,7,19,20,21,22,23,24,25,26,27]
The purpose of this Master Class Paper is to describe an emerging approach for the delivery of physical therapy care for Chronic low back pain (CLBP) that utilizes longitudinally supported self-management within a therapeutic alliance to develop individualized, patient-preferred approaches for activity-based self‐management. This approach is conceptualized as an alternative to the contemporary approach of short but intense episodes of care directed toward pain reduction
Summary
• Chronic low back pain (CLBP) is even more complicated than previously believed. • This condition is usually associated with substantial loss of muscle function and is often related to mal-adaptive changes in the way patients perceive and appraise pain. • These and other factors help to explain why CLBP typically has a long-term trajectory that is not strongly impacted by traditional physical therapy (PT) approaches that utilize brief, intense episodes of treatment. • Longitudinal care using assisted self-management strategies addresses the long-term trajectory of CLBP by emphasizing the formation of an ongoing therapeutic alliance between the patient and the PT that incorporates individualized, patient-preferred approaches for activity-based self-management. • This approach may provide the long-term stimuli needed to address the muscular and neurologic impairments associated with CLBP thus making it a useful alternative to the traditional approach of short but intense episodes of care, however additional research is needed.
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