Abstract
The purpose of this review is to provide a follow-up discussion to a companion article reviewing current models of low back and neck pain, focused on chronic and disabling primary pain of the spine. While the preceding article addresses risk factors, etiology, pathophysiology, and differential diagnosis of low back and neck pain, this article discusses the best available research regarding current management strategies for chronic primary pain of the spine and expands upon ways to improve these strategies. A review of the English medical literature was performed using search terms “chronic primary pain,” “low back pain,” OR “neck pain” AND “management,” “treatment,” “prevention,” or “biopsychosocial.” Additional searches were made using Google Scholar and PubMed search engines through April 18, 2020. The authors reviewed and identified 136 relevant articles to be used in this discussion. While certain elements of societal and legislative infrastructure hinder optimized implementation of evidence-based care, clinical research and updated practice guidelines advocate for the safe and cost-effective nonpharmacological interventions typically offered by chiropractors, physical therapies, and other manual therapists as first-line care. The authors expand upon these therapies individually to determine their relevance and contextual purpose. A framework for an integrative perspective, adopting concepts from biopsychosocial and behavioral models, is called to action to provide an improved understanding of the nature of chronic primary pain and to aid in patient-centered clinical decision-making.
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Abbreviations
- NSAIDs:
-
Nonsteroidal antiinflammatories
- TA:
-
Therapeutic alliance
- fMRI:
-
Functional magnetic resonance imaging
- CPG:
-
Clinical practice guideline
- NAD:
-
Neck pain and associated disorders
- SBST:
-
STarT Back screening tool
- OMPSQ:
-
Örebro Musculoskeletal Pain Screening Questionnaire
- CBT:
-
Cognitive behavioral therapy
- ACT:
-
Acceptance and commitment therapy
- MBSR:
-
Mindfulness-based stress reduction
- CBT-CP:
-
Cognitive behavioral therapy for chronic pain
- VA:
-
Veterans affairs
- SMT:
-
Spinal manipulation/mobilization technique
- VNS:
-
Vagal nerve stimulation
- PSNS:
-
Parasympathetic nervous system
- ABVN:
-
Auricular branch of the vagus nerve
- NTS:
-
Nucleus tractus solitarius
- TNF:
-
Tumor necrosis factor
- COPES:
-
Cooperative pain education and self-management
- CPSMP:
-
Chronic pain self-management program
- PMR:
-
Progressive muscle relaxation
- MM:
-
Mindfulness meditation
- SNS:
-
Sympathetic nervous system
- HPA:
-
Hypothalamic–pituitary–adrenal
- DSB:
-
Deep slow breathing
- CBT-I:
-
Cognitive behavioral therapy for insomnia
- ICD-11:
-
International Classification of Disease 11th edition
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NWK was a major contributor in concept development. TJW, CLB, NAH, and NWK performed the literature search, analyzed results, and drafted, revised, and approved the final manuscript. TJW was a major contributor in writing the manuscript.
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Williamson, T.J., Bolles, C.L., Hedges, N.A. et al. Chronic Primary Pain of the Spine: an Integrative Perspective Part 2. SN Compr. Clin. Med. 3, 473–489 (2021). https://doi.org/10.1007/s42399-021-00779-6
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DOI: https://doi.org/10.1007/s42399-021-00779-6