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• W1744371126 abstract "T he presence of chronic low back pain infers the failure of prior attempts at therapy in providing acceptable levels of improvement. This failure of expected efficacy demands that any new or additional treatment approaches must be predicated upon a reasonable chance for improvement. It is of greatest importance that the patient become pleased with the effects of the treatment offered. As one reviews the records of those with the “failed back syndrome” some important consistencies are noted. Understanding these basic issues that seem to reoccur in this difficult group of patients can become more important in developing treatment stratagems than the extent of the physical findings on examination or as seen in diagnostic studies. The concept of an interdisciplinary approach to the management of chronic low back pain evolved as a result of several important findings. First, the psychological and social problems faced by the patient were identified and defined. Second, techniques that dealt only with these issues were shown to be effective in improving function, drug use, and attitude about such issues as work and participation in family activities. The importance of this finding was that improvement could be documented without dealing, at all, with the physical problem, or the complaints related to it. Third, the psychological treatment approaches could be easily integrated into the medical care of the patient as a more powerful force for improvement than either the medical or the psychological or psychosocial approaches alone. Many physicians avoid trying to understand the psychosocial issues at all. This is understandable. Most physicians who deal with chronic low back pain are pragmatic in their approach. Depending on the importance of physical findings, reliability on the value of diagnostic procedures, and the dramatic effects that can be expected by surgery, all serve to make delving into the more esoteric realm of mind-and-body interplay somewhat foreign and difficult. Thus, these issues are relegated to others with more expertise in those areas. Unfortunately, this often does not result in the integration of recommendations, especially when they conflict, difficult to understand, or when they are complex. The interdisciplinary management of the chronic low back pain patient presumes an integration of approach that incorporates the psychological and physical aspects of care in a cohesive comprehensive program. It is the antithesis of the model of “serial consultation” wherein each presents views of the patient that never truly describe the problems identified in operational terms. Thus, in such situations, the treatment strategy is less likely to succeed. In the discussion to follow, some of the important similarities seen in patients with chronic low back pain will be presented as a model to better explain the reasons for the evolution of the chronic low back pain syndrome. The interdisciplinary model will be discussed in terms of its ability to blanket more completely the problems encountered. Finally, the results of the interdisciplinary approach will be presented as a means of providing principles of care for all physicians who treat those with chronic low back pain." @default.
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• W1744371126 date "1991-09-01" @default.
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• W1744371126 title "The interdisciplinary management of chronic low back pain" @default.
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• W1744371126 doi "https://doi.org/10.5555/uri:pii:104073839190031o" @default.
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