Chronic Primary Pain of the Spine: an Integrative Perspective Part 2

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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Fig. 1

Availability of Data and Materials

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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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Correspondence to Timothy J. Williamson.

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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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Keywords

  • Chronic pain
  • Spine
  • Low back pain
  • Neck pain
  • Management
  • Biopsychosocial