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bibliography*The PainScience Bibliography contains plain language summaries of thousands of scientific papers and others sources, like a specialized blog. This page is about a single scientific paper in the bibliography, O’Keeffe 2016.

Comparative Effectiveness of Conservative Interventions for Nonspecific Chronic Spinal Pain: Physical, Behavioral/Psychologically Informed, or Combined? A Systematic Review and Meta-Analysis


Tags: treatment, back pain, pain problems, spine

PainSci summary of O’Keeffe 2016?This page is one of thousands in the bibliography. It is not a general article: it is focused on a single scientific paper, and it may provide only just enough context for the summary to make sense. Links to other papers and more general information are provided at the bottom of the page, as often as possible. ★★★☆☆?3-star ratings are for typical studies with no more (or less) than the usual common problems. Ratings are a highly subjective opinion, and subject to revision at any time. If you think this paper has been incorrectly rated, please let me know.

The biopsychosocial (BPS) model is that pain is driven by social and psychological factors as well as biological ones (injury and pathology). This meta-analysis showed that there’s not much difference between treatments inspired by the BPS model and traditional “physical” therapy: it’s all equally underwhelming. Specifically, “behavioral/psychologically informed interventions,” with or without physical ones, performed just as poorly as physical treatments alone.

The meta-analysis is flawed, as most of them are, and it was harshly criticized in a letter to the editor, but the complaint can basically be chalked up to sour grapes because the authors “know” that BPS-inspired treatments are effective. While the turf-defending motives are depressingly obvious, I think everyone here is basically right: nothing about the BPS model of pain suggests it’s going to be easy to treat it “biopsychosocially,” but that also doesn’t mean we shouldn’t be trying.

As Dr. Lorimer Mosely wrote of this kerfuffle, “The biopsychosociality of pain might not necessarily mean biopsychosocial treatments work.” And, I would add, it means we should expect effective treatment to be hard to standardize and test. The poor performance of “psychologically informed” treatments in the scientific literature so far is hardly any kind of a surprise, and it is highly plausible that BPS-inspired treatment is still the least bad option we have.

~ Paul Ingraham

original abstractAbstracts here may not perfectly match originals, for a variety of technical and practical reasons. Some abstacts are truncated for my purposes here, if they are particularly long-winded and unhelpful. I occasionally add clarifying notes. And I make some minor corrections.

Nonspecific chronic spinal pain (NSCSP) is highly disabling. Current conservative rehabilitation commonly includes physical and behavioral interventions, or a combination of these approaches. Physical interventions aim to enhance physical capacity by using methods such as exercise, manual therapy, and ergonomics. Behavioral/psychologically informed interventions aim to enhance behaviors, cognitions, or mood by using methods such as relaxation and cognitive behavioral therapy. Combined interventions aim to target physical and also behavioral/psychological factors contributing to patients' pain by using methods such as multidisciplinary pain management programs. Because it remains unclear whether any of these approaches are superior, this review aimed to assess the comparative effectiveness of physical, behavioral/psychologically informed, and combined interventions on pain and disability in patients with NSCSP. Ten electronic databases were searched for randomized controlled trials (RCTs) including participants reporting NSCSP. Studies were required to have an "active" conservative treatment control group for comparison. Studies were not eligible if the interventions were from the same domain (eg, if the study compared 2 physical interventions). Study quality was assessed used the Cochrane Back Review Group risk of bias criteria. The treatment effects of physical, behavioral/psychologically informed, and combined interventions were assessed using meta-analyses. Twenty-four studies were included. No clinically significant differences were found for pain and disability between physical, behavioral/psychologically informed, and combined interventions. The simple categorization of interventions into physical, behavioral/psychologically informed, and combined could be considered a limitation of this review, because these interventions may not be easily differentiated to allow accurate comparisons to be made. Further work should consider investigating whether tailoring rehabilitation to individual patients and their perceived risk of chronicity, as seen in recent RCTs for low back pain, can enhance outcomes in NSCSP.

PERSPECTIVE: In this systematic review of RCTs in NSCSP, only small differences in pain or disability were observed between physical, behavioral/psychologically informed, and combined interventions.

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Specifically regarding O’Keeffe 2016:

This page is part of the PainScience BIBLIOGRAPHY, which contains plain language summaries of thousands of scientific papers & others sources. It’s like a highly specialized blog. A few highlights: