Effectiveness of a Multidisciplinary Treatment for Patients With Chronic Low Back Pain

Official title

Effectiveness of a Multidisciplinary Treatment for Patients With Chronic Low Back Pain (PAINDOC Protocol): Randomized, Parallel-group, Two-arm, Single-blind Clinical Trial (PAINDOC Project)

Overview

PAINDOC is a treatment program that includes 4 disciplines that, separately, have demonstrated their effectiveness in the treatment of chronic low back pain: education in pain neuroscience, therapeutic education (Empowered Relief®), psychotherapy based on cognitive-behavioral therapy and therapeutic exercise. The primary objective of the study is to evaluate the effectiveness of the PAINDOC multidisciplinary treatment program in reducing pain intensity and improving quality of life in persons with chronic low back pain referred to the pain unit of the Hospital Clinic of Barcelona, compared to usual care treatment. As secondary objectives, the present study aims to evaluate the effect of the PAINDOC program on: * The reduction of pain-related disability. * The reduction of pain catastrophizing. * The improvement in perceived social support. * The improvement in perceived autonomy (self-efficacy). * The reduction of analgesic, anti-inflammatory and adjuvant analgesic medication. The main questions it aims to answer are: * Is the proposed multidisciplinary treatment effective in improving pain-related outcomes? * Is the proposed multidisciplinary treatment effective in reducing analgesic medication? Participants will receive either usual care (pharmacological control) or the PAINDOC program, which consists of 7 multidisciplinary sessions within 2 months. There will be one therapeutic education session called Empowered Relief®, 2 pain neuroscience education sessions, one pain psychology session and 3 therapeutic education sessions. Besides, participants will be assessed using written questionnaires before treatment, at 3 months and at 6 months. Researchers will assess the effectiveness of the multidisciplinary treatment group comparing both groups to see if there is any difference in several pain-related outcomes.

Detailed description

Despite improving pharmacological and surgical medical treatment options, chronic low back pain is the most frequent pain disorder and a leading cause of disability. Over the past decades, clinicians have acknowledged that a broader view of disease and disability is needed in chronic conditions treatment. Therefore, biological, psychological and social factors must be addressed to improve such conditions.

Interventions

• Behavioral Multidisciplinary and multimodal intervention
  The PAINDOC Program consists in: * Therapeutic education: The therapeutic education block consists of 2 parts: a 2-hour education session called Empowered Relief® and 2 1-hour pain neuroscience education sessions. * Psychotherapy: The psychotherapy part consists of 1 group session of 1 hour, face-to-face and with groups of up to 15 people. * Therapeutic exercise: The therapeutic exercise module consists of 3 sessions of 1 hour each, face-to-face, with small groups of between 6 and 10 patients,
• Drug Usual Care
  The pharmacological treatment will be individualised according to pain intensity, contraindications and the appearance of adverse effects.

Primary outcome measures

• Pain Intensity. Changes from baseline to 6 months. [Time frame: Baseline, 3 months, 6 months]
• Health-related quality of life. Changes from baseline to 6 months. [Time frame: Baseline, 3 months, 6 months]

Secondary outcome measures (5)

• Pain-related Disability. Changes from baseline to 6 months. [Time frame: Baseline, 3 months, 6 months]
• Pain Catastrophizing. Changes from baseline to 6 months. [Time frame: Baseline, 3 months, 6 months]
• Perceived Social Support. Changes from baseline to 6 months. [Time frame: Baseline, 3 months, 6 months]
• Self-efficacy. Changes from baseline to 6 months. [Time frame: Baseline, 3 months, 6 months]
• Consumption of analgesic, anti-inflammatory and coadjuvant analgesic drugs [Time frame: Baseline, 3 months, 6 months]

Eligibility criteria

Inclusion criteria

• Patients over 18 years of age.
• Patients with primary chronic low back pain (non-specific chronic low back pain) of axial predominance.
• Experiencing pain at least 50% of the time over the last 6 months.
• Average weekly pain intensity equal or greater than 4 out of 10 on a verbal numerical scale.
• Be agreeable to receiving active, non-pharmacological and non-surgical treatment.

Exclusion criteria

• Inflammatory low back pain.
• History of cancer in the last 5 years.
• Unexplained and unintentional weight loss of 10 Kg or more over the preceding 12-month period.
• Lack of control of bowel and bladder function (cauda equina).
• Difficulty in performing the sessions due to severe physical disability.
• Diagnosis of severe mental illness (schizophrenia, major depression, bipolar disorder, etc.).
• Strong prescription opioid or parenteral medication addiction disorders.
• Technical-logistical problems (inability to attend treatment sessions or inability to fill out assessment questionnaires).
• Problems in understanding the content of the sessions (language barrier, severe hearing loss or severe cognitive impairment).
• Have sought compensation or entered into litigation in the preceding 12-month period.

Criteria are shown verbatim from the registry (in English). Final eligibility is always assessed by the study center.

Healthy volunteers: No

Study design

Allocation

Randomized

Model

Parallel assignment

Masking

Single blind

Primary purpose

Treatment

Study locations

Spain · 2 centers

• Hospital Clínic de Barcelona — Barcelona
• Hospital Clínic de Barcelona — Barcelona

Publications

• Qaseem A, Wilt TJ, McLean RM, Forciea MA; Clinical Guidelines Committee of the American College of Physicians; Denberg TD, Barry MJ, Boyd C, Chow RD, Fitterman N, Harris RP, Humphrey LL, Vijan S. Noninvasive Treatments for Acute, Subacute, and Chronic Low Back Pain: A Clinical Practice Guideline From the American College of Physicians. Ann Intern Med. 2017 Apr 4;166(7):514-530. doi: 10.7326/M16-23 PMID 28192789
• Bodes Pardo G, Lluch Girbes E, Roussel NA, Gallego Izquierdo T, Jimenez Penick V, Pecos Martin D. Pain Neurophysiology Education and Therapeutic Exercise for Patients With Chronic Low Back Pain: A Single-Blind Randomized Controlled Trial. Arch Phys Med Rehabil. 2018 Feb;99(2):338-347. doi: 10.1016/j.apmr.2017.10.016. Epub 2017 Nov 11. PMID 29138049
• Vlaeyen JWS, Maher CG, Wiech K, Van Zundert J, Meloto CB, Diatchenko L, Battie MC, Goossens M, Koes B, Linton SJ. Low back pain. Nat Rev Dis Primers. 2018 Dec 13;4(1):52. doi: 10.1038/s41572-018-0052-1. PMID 30546064
• Darnall BD, Roy A, Chen AL, Ziadni MS, Keane RT, You DS, Slater K, Poupore-King H, Mackey I, Kao MC, Cook KF, Lorig K, Zhang D, Hong J, Tian L, Mackey SC. Comparison of a Single-Session Pain Management Skills Intervention With a Single-Session Health Education Intervention and 8 Sessions of Cognitive Behavioral Therapy in Adults With Chronic Low Back Pain: A Randomized Clinical Trial. JAMA Netw Op PMID 34398206
• Ochandorena-Acha M, Dalmau-Roig A, Dursteler C, Vilchez-Oya F, Ferrer A, Martin-Villalba I, Obach A, Terradas-Monllor M. Acceptability of multimodal and multidisciplinary group-based program for chronic low back pain: a qualitative study. Physiother Theory Pract. 2025 May;41(5):981-997. doi: 10.1080/09593985.2024.2377343. Epub 2024 Jul 12. PMID 38994708
• Cohen SP, Vase L, Hooten WM. Chronic pain: an update on burden, best practices, and new advances. Lancet. 2021 May 29;397(10289):2082-2097. doi: 10.1016/S0140-6736(21)00393-7. PMID 34062143

Identifiers

NCT: NCT06679205 · HCB/2024/0791

Primary sources (government registries)

• ClinicalTrials.gov (US NIH)

View this study on ClinicalTrials.gov ↗