It is no secret that chronic diseases contribute heavily to the global burden of disease, and that musculoskeletal conditions such as back and neck pain are big contributors to causes of disability. Thus, it is imperative that people living with these conditions have the best skills and knowledge possible to manage these conditions in everyday life. This commonly involves contact with health care providers, but for most of the time, individuals are managing their own health independently. A new randomised controlled trial has examined the effect of weekly monitoring on back pain outcomes, and its results are quite meaningful for chiropractors and chiropractic practice members alike.
While chiropractors can check and adjust our practice members, the power of self-management away from the practice is essential to build upon the impact of the adjustment. Self-management can take on many forms including engaging in a healthy lifestyle and behaviours, symptom management, and self-monitoring of the condition. But it is this last important issue that the current study takes on .
In the cases of musculoskeletal pain, self-monitoring is more subjective than the monitoring that can be done for other conditions (For example, having to gauge pain vs measuring blood glucose levels). Awareness of pain might be helpful for people to understand the variation over time and reflect on how the pain relates to other areas of life. However, continuous focus on pain may also negatively affect pain intensity and pain behaviours. It is important to investigate whether self-monitoring as a part of the interventions given to patients could be harmful, or helpful, or neither.
The study in question was a non-randomised controlled study involving adults with a primary complain of low back pain. They were recruited from a convenience sample of ten Danish chiropractic clinics. In total, 1623 patients were enrolled in the SMS-tracking sample (weekly SMS-tracking of pain in addition to follow up questionnaires. All patients were invited to complete the baseline and follow up questionnaires)
Of the 1623 participants, some 1225 were included in the control group. The rest were assigned to the study group which received SMS tracking messages every week starting seven days after enrolment in the program.
The nature of the questions were as follows;
- How many days have you had back pain within the last 7 days? (answering with a rating 0-7)
- How severe was the pain typically on a scale of 0 to 10?
- How many days were you home last week from work or study because of your back pain? (answering with a rating 0-7)
Individuals who responded with a 0 to the first message were not sent the two following messages. If no response was registered within 2 days, participants received one automated reminder. The follow ups occurred at 2 weeks, 3 and 12 months. At the 12 month follow up there was a 65% and 62% response rate from the original sample of the control and SMS-tracking group respectively. By comparison, there was a 73% response rate for both groups at the previous questionnaire.
At the one-year follow-up, low back pain intensity (the primary outcome) was measured on a 0-10 numeric rating pain scale. Moderate to severe pain at follow-up was defined as rating of less than 3. Activity limitation and pain control was also measured at the one year follow up, this time measured against the Roland Morris Disability Questionnaire. Pain control, or the individual’s ability to cope with pain, was measured by the Orebro Musculoskeletal Pain Questionnaire
Interestingly the primary outcome – low back pain intensity – was slightly lower in the SMS-tracking group than the control group. While there were no statistically significant differences in the secondary outcomes, there were some changes in some of the measures.Neither of the positive effects were large enough to seem clinically relevant as a treatment effect, but nor does it support the thinking that weekly pain monitoring does have a harmful effect on pain outcomes. The authors noted that, “For the time being, it seems that the simple advice to systematically monitor pain could potentially prove helpful for patients with [Low Back Pain]. It is possible that self-monitoring leads to self-reflection, which in turn might support helpful habits and facilitate positive behavior changes.”
While this study might seem like a drop in the bucket when it comes to improving quality of life for chronic low back pain sufferers, it does provide opportunities for further research and for clinicians working with the potential in terms of patient self-reflection. While this study did provide feedback to patients who were part of the monitoring, future research may explain how we can harness and expand the positive effect.
It is interesting to note that the SMS-tracked group reported a slightly higher level of education, a lower workload, and a shorter baseline duration of low back pain than the much larger control group. These factors would need to be controlled for in further studies, but it is certainly an interesting line of thought indeed.
- Kongsted, A., Jensen, T.S., Doktor, K. et al. Effects of weekly pain monitoring on back pain outcomes: a non-randomised controlled study. Chiropr Man Therap. 2021. 29;37. https://doi.org/10.1186/s12998-021-00393-2