Socioeconomic disparities in chronic low back pain

Chronic pain is a widespread public health problem that affects at least 37% of U.S. adults. Low back pain (LBP) is the most common type of pain and results in over $100 billion each year in total direct and indirect (e.g., lost wages, reduced productivity) costs in the U.S. Chronic LBP (cLBP) is associated with limitations in physical function, work or school activities, and social activities, resulting in substantial impacts on individuals and families. The prevalence of back pain is higher among women, older adults and those with lower levels of education and a lower annual income. Literature reviews often document racial/ethnic disparities in pain treatment due to issues within the medical system, attitudes and beliefs of health care providers, and patient factors that result from each individual's pain experience. The biopsychosocial model conceptualizes the individual experience of pain with interrelated causes and manifestations in physical (e.g., genetics, injuries), psychological (e.g., depression, pain beliefs), and social (e.g., social support, health behaviors) dimensions. Common of assessments of cLBP include measures of pain intensity and measures of functional limitations. This research aims to explore associations of the seriousness of LBP with multiple sociodemographic characteristics. Two clinical research trials enrolled a diverse population to participant in cLBP research. All 415 participants completed baseline questionnaires, including measures of LBP intensity and LBP-related dysfunction, before randomization and participation began. The majority of participants were female, non-Hispanic black, and had an annual income <$20,000. This study population had a high level of pain intensity and LBP-related dysfunction, although the two outcomes were only moderately correlated. Two multivariate logistic regression models, one for each outcome) revealed different sets of predictors, although race/ethnicity, education, and employment status were present in both final models. LBP is a complex condition that requires differences in seriousness to be considered in relation to the multiple facets of the biopsychosocial model. Differences in seriousness of pain can in part be attributed to variability in perceptions and reports of patients. Patient perceptions as a result of coping strategies, behaviors, and perceived racial discrimination are discussed. Pain intensity and related function are important and interacting measures of cLBP in both clinical and research settings. Assessment of functional limitation holds value for predicting important disability outcomes such as the ability to work. LBP intensity ratings may reflect the direct and indirect impact of LBP treatment on psychological and social experiences of chronic pain. Medical professionals must acquire comprehensive knowledge about health disparities, cultural influences, and the role of individual behavioral characteristics in order to adequately create patient-centered treatment plans

Yoga, Physical Therapy, or Education for Chronic Low Back Pain: A Randomized Noninferiority Trial

Background: Yoga is effective for mild to moderate chronic low back pain (cLBP), but its comparative effectiveness with physical therapy (PT) is unknown. Moreover, little is known about yoga\u27s effectiveness in underserved patients with more severe functional disability and pain. Objective: To determine whether yoga is noninferior to PT for cLBP. Design: 12-week, single-blind, 3-group randomized noninferiority trial and subsequent 40-week maintenance phase. (ClinicalTrials.gov: NCT01343927). Setting: Academic safety-net hospital and 7 affiliated community health centers. Participants: 320 predominantly low-income, racially diverse adults with nonspecific cLBP. Intervention: Participants received 12 weekly yoga classes, 15 PT visits, or an educational book and newsletters. The maintenance phase compared yoga drop-in classes versus home practice and PT booster sessions versus home practice. Measurements: Primary outcomes were back-related function, measured by the Roland Morris Disability Questionnaire (RMDQ), and pain, measured by an 11-point scale, at 12 weeks. Prespecified noninferiority margins were 1.5 (RMDQ) and 1.0 (pain). Secondary outcomes included pain medication use, global improvement, satisfaction with intervention, and health-related quality of life. Results: One-sided 95% lower confidence limits were 0.83 (RMDQ) and 0.97 (pain), demonstrating noninferiority of yoga to PT. However, yoga was not superior to education for either outcome. Yoga and PT were similar for most secondary outcomes. Yoga and PT participants were 21 and 22 percentage points less likely, respectively, than education participants to use pain medication at 12 weeks. Improvements in yoga and PT groups were maintained at 1 year with no differences between maintenance strategies. Frequency of adverse events, mostly mild self-limited joint and back pain, did not differ between the yoga and PT groups. Limitations: Participants were not blinded to treatment assignment. The PT group had disproportionate loss to follow-up. Conclusion: A manualized yoga program for nonspecific cLBP was noninferior to PT for function and pain. Primary Funding Source: National Center for Complementary and Integrative Health of the National Institutes of Health

Embodied health: the effects of a mind&#x2013;body course for medical students

Objective: An effective career in medicine requires empathy and compassion, yet the demands of a medical education increase stress and decrease students&#x2019; ability to connect with patients. However, research suggests mind-body practices improve psychological well-being. This study aimed to evaluate the psychological effects on medical students of an 11-week elective course, Embodied Health or EH, which combines yoga and meditation with neuroscience didactics. Methods: The effects on 27 first- and second-year medical students were evaluated via surveys in four areas: empathy, perceived stress, self-regulation, and self-compassion. Scales used were 1. Jefferson Scale of Physician Empathy, which measures empathy among health students and professionals and medical students on a scale of 1 (least empathetic) to 7 (most empathetic); 2. Cohen&#x0027;s Perceived Stress Scale, a measure of the perceived uncontrollability of respondents&#x0027; lives, from 0 (least stressed) to 4 (most stressed); 3. Self-Regulation Questionnaire, which measures the development and maintenance of planned behavior to achieve goals, from 1 (least self-regulated) to 5 (most self-regulated); and 4. Self-Compassion Scale, which measures self-criticism, from 1 (least self-compassionate) to 5 (most self-compassionate). Students also reflected on EH&#x0027;s impact on their well-being in a post-course essay. Results: Self-regulation and self-compassion rose 0.13 (SD 0.20, p&#x200A;=&#x200A;0.003) and 0.28 (SD 0.61, p&#x200A;=&#x200A;0.04), respectively. Favorable changes were also seen in empathy and perceived stress, which went up by 0.11 (SD 0.50, p&#x200A;=&#x200A;0.30) and down by 0.05 (SD 0.62, p&#x200A;=&#x200A;0.70), respectively; these changes did not reach statistical significance. Students&#x2019; essays were found to discuss the following recurrent themes: 1) Reconnection between mind and body; 2) Community in a competitive environment; 3) Increased mindfulness; 4) Confidence in use of mind-body skills with patients; and 5) Stress management. These themes overlapped with the measures EH affected quantitatively. Conclusion: A mind-body course for medical students increased self-regulation and self-compassion. Qualitative themes discussed in students&#x2019; post-course essays reflected these effects