Search

Under the auspices of the Dutch Institute for Healthcare Improvement (CBO), a guideline has been developed for the diagnosis and treatment of aspecific low-back pain, based on the recent scientific literature. So-called 'red flags' are used to identify physical disorders. To obtain insight into psychosocial factors, 'yellow flags' are used. Acute low-back pain (0-12 weeks) is treated in a time-contingent manner. Staying active is better than bed rest. If chronicity threatens, exercise therapy can be advised. As part of an activating management, manipulation can be used. For pain relief, paracetamol is the drug of choice. The treatment of chronic low-back pain is aimed at the optimisation of the patients' functionality. Staying active is preferred here as well. Varied exercise therapy is advised. Back training may be considered. Manipulation can be used as part of an activating management. Paracetamol is preferred for pain relief. There is a limited role for percutaneous lumbar facet denervation. Behaviour therapy can be employed and there is a place for multidisciplinary programmes if other methods of treatment have proved insufficiently effective.

Objective: To evaluate the results of a multidisciplinary and behavioral program for chronic back pain., Design: Prospective cohort study., Method: In 1996, a total of 143 patients with chronic back pain participated in a 4-week multidisciplinary and behavioral treatment program in an outpatient centre for work reintegration (Rug AdviesCentrum) in Zeist, Eindhoven and Noordwijk, the Netherlands. At the start and six months after termination, data were collected on trunk muscle performance, pain intensity, disability and stress related physical complaints, and after 6 months about return to work, analgesics use, and health care utilization. Score differences between the first and the second measurements were tested on statistical significance using paired t-tests and on clinical relevance using the reliable change-index., Results: The study group comprised 99 males and 44 females with a mean age of 41.6 years (range: 23-58). After 6 months the outcome variables were significantly improved statistically: depending on the outcome variable used, the improvement was clinically relevant in 44-91% of patients. The obtained percentage of full return to work at 6-months follow-up was 87%, while 80% had used no pain killers and 91% had made no use of health care facilities., Conclusion: The program resulted in important improvements in patients with chronic back pain.