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4. The Fit-for-Purpose Model: Conceptualizing and Managing Chronic Nonspecific Low Back Pain as an Information Problem

Author

Wand, Benedict M., Cashin, Aidan G., McAuley, James H., Bagg, Matthew K., Orange, Gemma M., and Moseley, G. Lorimer

Subjects
Chronic pain -- Care and treatment -- Causes of -- Models, Low back pain -- Care and treatment -- Causes of -- Models
Abstract

Chronic nonspecific low back pain (LBP) is a complex and multifaceted problem. The following Perspective piece tries to help make sense of this complexity by describing a model for the development and maintenance of persistent LBP that integrates modifiable factors across the biopsychosocial spectrum. The Fit-for-Purpose model posits the view that chronic nonspecific LBP represents a state in which the person in pain holds strong and relatively intransient internal models of an immutably damaged, fragile, and unhealthy back, and information that supports these models is more available and trustworthy than information that counters them. This Perspective proposes a corresponding treatment framework for persistent pain that aims to shift internal models of a fragile, damaged, unhealthy, and unchangeable self toward the formulation of the back as healthy, strong, adaptable, and fit for purpose and to provide the system with precise and trustworthy evidence that supports this supposition while minimizing information that works against it. Keywords: Back Pain, Biopsychosocial, Chronic Pain, Predictive Processing, Rehabilitation, Introduction Chronic nonspecific low back pain (CNSLBP) is a common and complex problem with considerable personal and societal consequences. (1-3) Prognosis is unfavorable, with recovery occurring in less than one-half [...]

Published
2023
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16. Changing the Narrative in Diagnosis and Management of Pain in the Sacroiliac Joint Area

Author

Palsson, Thorvaldur S., Gibson, William, Darlow, Ben, Bunzli, Samantha, Lehman, Gregory, Rabey, Martin, Moloney, Niamh, Vaegter, Henrik B., Bagg, Matthew K., and Travers, Mervyn

Subjects
Back pain -- Care and treatment -- Diagnosis, Patient education, Pain management, Neurophysiology, Pregnancy, Health education, Company business management, Health
Abstract

The sacroiliac joint (SIJ) is often considered to be involved when people present for care with low back pain where SIJ is located. However, determining why the pain has arisen can be challenging, especially in the absence of a specific cause such as pregnancy, disease, or trauma, when the SIJ might be identified as a source of symptoms with the help of manual clinical tests. Nonspecific SIJ-related pain is commonly suggested to be causally associated with movement problems in the SIJ(s)--a diagnosis traditionally derived from manual assessment of movements of the SIJ complex. Management choices often consist of patient education, manual treatment, and exercise. Although some elements of management are consistent with guidelines, this Perspective article argues that the assumptions on which these diagnoses and treatments are based are problematic, particularly if they reinforce unhelpful, pathoanatomical beliefs. This article reviews the evidence regarding the clinical detection and diagnosis of SIJ movement dysfunction. In particular, it questions the continued use of assessing movement dysfunction despite mounting evidence undermining the biological plausibility and subsequent treatment paradigms based on such diagnoses. Clinicians are encouraged to align their assessment methods and explanatory models with contemporary science to reduce the risk of their diagnoses and choice of intervention negatively affecting clinical outcomes., Low back pain (LBP) is the leading cause of disability worldwide. (1) A significant proportion (16%-35%) of these presentations are thought to involve the sacroiliac joint (SIJ) complex. (2-5) The [...]

Published
2019
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18. Comparative effectiveness and safety of analgesic medicines for adults with acute non-specific low back pain: systematic review and network meta-analysis

Author

Wewege, Michael A, primary, Bagg, Matthew K, additional, Jones, Matthew D, additional, Ferraro, Michael C, additional, Cashin, Aidan G, additional, Rizzo, Rodrigo RN, additional, Leake, Hayley B, additional, Hagstrom, Amanda D, additional, Sharma, Saurab, additional, McLachlan, Andrew J, additional, Maher, Christopher G, additional, Day, Richard, additional, Wand, Benedict M, additional, O’Connell, Neil E, additional, Nikolakopolou, Adriani, additional, Schabrun, Siobhan, additional, Gustin, Sylvia M, additional, and McAuley, James H, additional

Published
2023
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19. Pharmacological treatments for low back pain in adults: an overview of Cochrane Reviews

Author

Cashin, Aidan G., Wand, Benedict M., O'Connell, Neil E., Lee, Hopin, Rizzo, Rodrigo R.N., Bagg, Matthew K., O'Hagan, Edel, Maher, Christopher G., Furlan, Andrea D., van Tulder, Maurits W., McAuley, James H., Cashin, Aidan G., Wand, Benedict M., O'Connell, Neil E., Lee, Hopin, Rizzo, Rodrigo R.N., Bagg, Matthew K., O'Hagan, Edel, Maher, Christopher G., Furlan, Andrea D., van Tulder, Maurits W., and McAuley, James H.

Abstract

BACKGROUND: Pharmacological interventions are the most used treatment for low back pain (LBP). Use of evidence from systematic reviews of the effects of pharmacological interventions for LBP published in the Cochrane Library, is limited by lack of a comprehensive overview.OBJECTIVES: To summarise the evidence from Cochrane Reviews of the efficacy, effectiveness, and safety of systemic pharmacological interventions for adults with non-specific LBP.METHODS: The Cochrane Database of Systematic Reviews was searched from inception to 3 June 2021, to identify reviews of randomised controlled trials (RCTs) that investigated systemic pharmacological interventions for adults with non-specific LBP. Two authors independently assessed eligibility, extracted data, and assessed the quality of the reviews and certainty of the evidence using the AMSTAR 2 and GRADE tools. The review focused on placebo comparisons and the main outcomes were pain intensity, function, and safety.MAIN RESULTS: Seven Cochrane Reviews that included 103 studies (22,238 participants) were included. There is high confidence in the findings of five reviews, moderate confidence in one, and low confidence in the findings of another. The reviews reported data on six medicines or medicine classes: paracetamol, non-steroidal anti-inflammatory drugs (NSAIDs), muscle relaxants, benzodiazepines, opioids, and antidepressants. Three reviews included participants with acute or sub-acute LBP and five reviews included participants with chronic LBP. Acute LBP Paracetamol There was high-certainty evidence for no evidence of difference between paracetamol and placebo for reducing pain intensity (MD 0.49 on a 0 to 100 scale (higher scores indicate worse pain), 95% CI -1.99 to 2.97), reducing disability (MD 0.05 on a 0 to 24 scale (higher scores indicate worse disability), 95% CI -0.50 to 0.60), and increasing the risk of adverse events (RR 1.07, 95% CI 0.86 to 1.33). NSAIDs There was moderate-certainty

Published
2023
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20. “My Back is Fit for Movement”: A Qualitative Study Alongside a Randomized Controlled Trial for Chronic Low Back Pain

Author

Rizzo, Rodrigo R.N., primary, Wand, Benedict M., additional, Leake, Hayley B, additional, O'Hagan, Edel T., additional, Bagg, Matthew K., additional, Bunzli, Samantha, additional, Traeger, Adrian C., additional, Gustin, Sylvia M., additional, Moseley, G. Lorimer, additional, Sharma, Saurab, additional, Cashin, Aidan G., additional, and McAuley, James H., additional

Published
2022
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24. Development of a booster intervention for graded sensorimotor retraining (RESOLVE) in people with persistent low back pain: A nested, randomised, feasibility trial.

Author

O'Hagan, Edel T., Cashin, Aidan G., Rizzo, Rodrigo R. N., Leake, Hayley B., Zahara, Pauline, Bagg, Matthew K., Wand, Benedict M., and McAuley, James H.

Subjects
CHRONIC pain treatment, LUMBAR pain, PILOT projects, PAIN measurement, SELF-management (Psychology), TELEPHONES, MOTIVATIONAL interviewing, PSYCHOLOGISTS, HUMAN services programs, RANDOMIZED controlled trials, CONCEPTUAL structures, COMPARATIVE studies, DESCRIPTIVE statistics, HEALTH care teams, RESEARCH funding, STATISTICAL sampling, EXERCISE physiologists, EXERCISE therapy, SOMATOSENSORY disorders, PAIN management
Abstract

Introduction: Low back pain contributes to an increasing global health burden exacerbated by unsustained improvements from current treatments. There is a need to develop, and test interventions to maintain initial improvements from low back pain treatments. One option is to implement a booster intervention. This study aimed to develop and test the feasibility of implementing a booster intervention delivered remotely to supplement the benefits from a complex intervention for chronic low back pain. Method: This study was nested in the RESOLVE trial. The booster intervention was developed by an expert group, including a clinical psychologist, exercise physiologist and physiotherapists, and based on a motivational interviewing framework. We developed a conversational flow chart to support the clinician to guide participants towards achieving their pre‐specified personal goals and future low back pain self‐management. Participants with chronic low back pain who were aged over 18 years and fluent in English were recruited. The booster intervention was delivered in one session, remotely, by telephone. The intervention was considered feasible if: participants were able to be contacted or <3 contacts were necessary to arrange the booster session; there were sufficient willing participants (<15% of sample unwilling to participate); and participants and research clinicians reported a perceived benefit of >7/10. Results: Fifty participants with chronic non‐specific low back pain were recruited to test the feasibility of implementing the booster intervention. Less than three contact attempts were necessary to arrange the booster session, only one participant declined to participate. Participants perceived the session to be beneficial; on a 0 to 10 scale of perceived benefit, the average score recorded was 8.3 (SD 2.0). Clinicians also reported a moderate perceived benefit to the participant; the average score recorded by clinicians was 6.3 (SD 1.6). Conclusion: We developed a step by step, simple booster intervention that was perceived to be beneficial to participants with chronic low back pain. The booster can feasibly be delivered remotely following a complex intervention. [ABSTRACT FROM AUTHOR]

Published
2023
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25. Effect of Graded Sensorimotor Retraining on Pain Intensity in Patients With Chronic Low Back Pain

Author

Bagg, Matthew K., primary, Wand, Benedict M., additional, Cashin, Aidan G., additional, Lee, Hopin, additional, Hübscher, Markus, additional, Stanton, Tasha R., additional, O’Connell, Neil E., additional, O’Hagan, Edel T., additional, Rizzo, Rodrigo R. N., additional, Wewege, Michael A., additional, Rabey, Martin, additional, Goodall, Stephen, additional, Saing, Sopany, additional, Lo, Serigne N., additional, Luomajoki, Hannu, additional, Herbert, Robert D., additional, Maher, Chris G., additional, Moseley, G. Lorimer, additional, and McAuley, James H., additional

Published
2022
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26. Effect of graded sensorimotor retraining on pain intensity in patients with chronic low back pain : a randomized clinical trial

Author

Bagg, Matthew K., Wand, Benedict M., Cashin, Aidan G., Lee, Hopin, Hübscher, Markus, Stanton, Tasha R., O'Connell, Neil E., O'Hagan, Edel T., Rizzo, Rodrigo R. N., Wewege, Michael A., Rabey, Martin, Goodall, Stephen, Saing, Sopany, Lo, Serigne N., Luomajoki, Hannu, Herbert, Robert D., Maher, Chris G., Moseley, G. Lorimer, McAuley, James H., Bagg, Matthew K., Wand, Benedict M., Cashin, Aidan G., Lee, Hopin, Hübscher, Markus, Stanton, Tasha R., O'Connell, Neil E., O'Hagan, Edel T., Rizzo, Rodrigo R. N., Wewege, Michael A., Rabey, Martin, Goodall, Stephen, Saing, Sopany, Lo, Serigne N., Luomajoki, Hannu, Herbert, Robert D., Maher, Chris G., Moseley, G. Lorimer, and McAuley, James H.

Abstract

Importance: The effects of altered neural processing, defined as altering neural networks responsible for perceptions of pain and function, on chronic pain remains unclear. Objective:To estimate the effect of a graded sensorimotor retraining intervention (RESOLVE) on pain intensity in people with chronic low back pain. Design, setting and participants: This parallel, 2-group, randomized clinical trial recruited participants with chronic (>3 months) nonspecific low back pain from primary care and community settings. A total of 276 adults were randomized (in a 1:1 ratio) to the intervention or sham procedure and attention control groups delivered by clinicians at a medical research institute in Sydney, Australia. The first participant was randomized on December 10, 2015, and the last was randomized on July 25, 2019. Follow-up was completed on February 3, 2020. Interventions: Participants randomized to the intervention group (n = 138) were asked to participate in 12 weekly clinical sessions and home training designed to educate them about and assist them with movement and physical activity while experiencing lower back pain. Participants randomized to the control group (n = 138) were asked to participate in 12 weekly clinical sessions and home training that required similar time as the intervention but did not focus on education, movement, and physical activity. The control group included sham laser and shortwave diathermy applied to the back and sham noninvasive brain stimulation. Main outcomes and measures: The primary outcome was pain intensity at 18 weeks, measured on an 11-point numerical rating scale (range, 0 [no pain] to 10 [worst pain imaginable]) for which the between-group minimum clinically important difference is 1.0 point. Results: Among 276 randomized patients (mean [SD] age, 46 [14.3] years; 138 [50%] women), 261 (95%) completed follow-up at 18 weeks. The mean pain intensity was 5.6 at baseline and 3.1 at 18 weeks in the intervention group and 5.8 at ba

Published
2022

27. Additional file 1 of Feasibility of an Audit and Feedback Intervention to Facilitate Journal Policy Change Towards Greater Promotion of Transparency and Openness in Sports Science Research

Author

Hansford, Harrison J., Cashin, Aidan G., Bagg, Matthew K., Wewege, Michael A., Ferraro, Michael C., Kianersi, Sina, Mayo-Wilson, Evan, Grant, Sean P., Toomey, Elaine, Skinner, Ian W., McAuley, James H., Lee, Hopin, and Jones, Matthew D.

Abstract

Additional file 1. Supplementary Material 1. Letter template. Supplementary Material 2. ICMJE disclosure of conflict of interest form and levels. Supplementary Material 3. Email template to journal editors.

Published
2022
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29. Efficacy, acceptability, and safety of muscle relaxants for adults with non-specific low back pain: systematic review and meta-analysis

Author

Cashin, Aidan G, primary, Folly, Thiago, additional, Bagg, Matthew K, additional, Wewege, Michael A, additional, Jones, Matthew D, additional, Ferraro, Michael C, additional, Leake, Hayley B, additional, Rizzo, Rodrigo R N, additional, Schabrun, Siobhan M, additional, Gustin, Sylvia M, additional, Day, Richard, additional, Williams, Christopher M, additional, and McAuley, James H, additional

Published
2021
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30. Investigating the Mechanisms of Graded Sensorimotor Precision Training in Adults With Chronic Nonspecific Low Back Pain: Protocol for a Causal Mediation Analysis of the RESOLVE Trial

Author

Cashin, Aidan G, primary, Lee, Hopin, additional, Bagg, Matthew K, additional, Wand, Benedict M, additional, O'Hagan, Edel, additional, Rizzo, Rodrigo R N, additional, Stanton, Tasha R, additional, Moseley, G Lorimer, additional, and McAuley, James H, additional

Published
2021
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33. Non-pharmacological and non-surgical treatments for low back pain in adults: an overview of Cochrane Reviews

Author

Cashin, Aidan G., Rizzo, Rodrigo R.N., Wand, Benedict M., O'Connell, Neil E., Lee, Hopin, Bagg, Matthew K., O'Hagan, Edel, Maher, Christopher G., Furlan, Andrea D., van Tulder, Maurits W., McAuley, James H., Cashin, Aidan G., Rizzo, Rodrigo R.N., Wand, Benedict M., O'Connell, Neil E., Lee, Hopin, Bagg, Matthew K., O'Hagan, Edel, Maher, Christopher G., Furlan, Andrea D., van Tulder, Maurits W., and McAuley, James H.

Abstract

Objectives: This is a protocol for a Cochrane Review (overview). The objectives are as follows:. 1. Provide accessible, high-quality evidence on the effects of non-pharmacological interventions for people with LBP. 2. To highlight areas of remaining uncertainty and gaps in the evidence regarding the effects of non-pharmacological interventions for people with LBP.

Published
2021
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39. Pharmacological treatments for low back pain in adults: an overview of Cochrane Reviews

Author

Cashin, Aidan G., Wand, Benedict M., O'Connell, Neil E., Lee, Hopin, Bagg, Matthew K., O'Hagan, Edel, Maher, Christopher G., Furlan, Andrea D., van Tulder, Maurits W., McAuley, James H., Cashin, Aidan G., Wand, Benedict M., O'Connell, Neil E., Lee, Hopin, Bagg, Matthew K., O'Hagan, Edel, Maher, Christopher G., Furlan, Andrea D., van Tulder, Maurits W., and McAuley, James H.

Abstract

Objectives: This is a protocol for a Cochrane Review (overview). The objectives are as follows:. To provide accessible, high-quality evidence on the effects of systemic pharmacological interventions for people with non-specific low back pain.

Published
2020
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40. The RESOLVE Trial for people with chronic low back pain: statistical analysis plan

Author

Bagg, Matthew K., primary, Lo, Serigne, additional, Cashin, Aidan G., additional, Herbert, Rob D., additional, O’Connell, Neil E., additional, Lee, Hopin, additional, Hübscher, Markus, additional, Wand, Benedict M., additional, O’Hagan, Edel, additional, Rizzo, Rodrigo R.N., additional, Moseley, G. Lorimer, additional, Stanton, Tasha R., additional, Maher, Christopher G., additional, Goodall, Stephen, additional, Saing, Sopany, additional, and McAuley, James H., additional

Published
2021
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42. Investigating the Mechanisms of Graded Sensorimotor Precision Training in Adults With Chronic Nonspecific Low Back Pain: Protocol for a Causal Mediation Analysis of the RESOLVE Trial (Preprint)

Author

Cashin, Aidan G, primary, Lee, Hopin, additional, Bagg, Matthew K, additional, Wand, Benedict M, additional, O'Hagan, Edel, additional, Rizzo, Rodrigo R N, additional, Stanton, Tasha R, additional, Moseley, G Lorimer, additional, and McAuley, James H, additional

Published
2020
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43. Author Response to Cibulka

Author

Palsson, Thorvaldur S, primary, Gibson, William, additional, Darlow, Ben, additional, Bunzli, Samantha, additional, Lehman, Gregory, additional, Rabey, Martin, additional, Moloney, Niamh, additional, Vaegter, Henrik B, additional, Bagg, Matthew K, additional, and Travers, Mervyn, additional

Published
2020
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47. Transparent and reproducible pain research: a critical review

Author

Lee, Hopin, Lamb, Sarah E., Bagg, Matthew K., Toomey, Elaine, Cashin, Aidan G., and Moseley, G. Lorimer

Subjects
Pain research, Reproducible, Replicable
Abstract

Recently, the degree to which scientific publications provide a reliable source of information has come under intense scrutiny. Reports suggest that a substantial amount of published literature is likely to be biased,28 distorted,27,53 and nonreproducible.7,50 This cuts across basic,10,55 preclinical,1,16 and clinical research.4,50 Although controversial, some have claimed that nonreproducible preclinical research consumes $28 billion/year (USD)16 and that 85% of biomedical research resources are wasted on biased research.35 The response from the scientific and policy community has been to identify common practices that contribute to the problem and develop methods to counteract them.47 This matter is very relevant to the pain field.1 Understanding the causes of nonreproducible and nonreplicable research and its ultimate impact on how we prevent and treat pain should assist pain researchers to improve the reproducibility and replicability of their work. The distinction between reproducibility and replicability is presented in Figure 1 and defined elsewhere.51 This article aims to: (1) outline the drivers of nonreproducible and nonreplicable research using examples from pain sciences and broader research fields; and (2) provide an overview of potential solutions and practices that could improve the reproducibility and replicability of pain research. peer-reviewed 2019-09-01

Published
2018

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