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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Availability of Data and Materials
Functional magnetic resonance imaging
Clinical practice guideline
Neck pain and associated disorders
STarT Back screening tool
Örebro Musculoskeletal Pain Screening Questionnaire
Cognitive behavioral therapy
Acceptance and commitment therapy
Mindfulness-based stress reduction
Cognitive behavioral therapy for chronic pain
Spinal manipulation/mobilization technique
Vagal nerve stimulation
Parasympathetic nervous system
Auricular branch of the vagus nerve
Nucleus tractus solitarius
Tumor necrosis factor
Cooperative pain education and self-management
Chronic pain self-management program
Progressive muscle relaxation
Sympathetic nervous system
Deep slow breathing
Cognitive behavioral therapy for insomnia
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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
- Chronic pain
- Low back pain
- Neck pain