Journal of Traditional Medical Complementary Therapies

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An Integrative Approach to Patients with Chronic Back Pain: A Cross-Sectional Study
Kronik Sırt Ağrısı Olan Hastaların Tedavisinde Bütüncül Bir Yaklaşım: Kesitsel Bir Araştırma
Mustafa SÜRENa , Serkan DOĞRUb , Tuğba KARAMANc , Mehtap BALTAc, Serkan KARAMANc , Tuğba AÇIKGÖZc , Cihat AYAZc , İsmail OKANd
aDepartment of Anesthesiology and Reanimation, Samsun University Faculty of Medicine, Samsun, Türkiye
bDepartment of Anesthesiology and Reanimation, University of Health Sciences Mersin City Training and Research Hospital, Mersin, Türkiye
cDepartment of Anesthesiology and Reanimation, Tokat Gaziosmanpaşa University Faculty of Medicine, Tokat, Türkiye
dDepartment of General Surgery, İstanbul Medeniyet University Göztepe Prof. Dr. Süleyman Yalçın City Hospital, İstanbul, Türkiye
J Tradit Complem Med. 2023;6(3):211-8
doi: 10.5336/jtracom.2022-93504
Article Language: EN
Full Text
ABSTRACT
 Objective: Chronic back pain is a complex, debilitating condition necessitating a vast amount of resources. In the present study, we aimed to evaluate the efficacy of an integrative pain approach for treating patients with chronic back pain in a setting where integrative medicine is still largely unknown. Material and Methods: The program included patients with chronic back pain who were admitted to the algology outpatient unit and treated with an integrative approach. The patients' demographic and clinical data and their assessment scores, such as Numerical Rating Scale (NRS), Pain Catastrophizing Scale (PCS), and Beck Anxiety Inventory (BAI) scores, during the first and last visits, were collected during the program. After two months, the data were retrieved from the files and retrospectively evaluated. Results: In total, 96 patients were recruited to the study. Their mean age was 46.52±13 years; 82.3% of the patients were female. The patients' commitment to the integrative pain treatment approach gradually declined over time. Only 10.4% of them completed the whole treatment program. The NRS and PCS scores significantly decreased after the program (NRS: 7.75±2.21 vs. 5.75±3.3, p=0.027; PCS: 40.22±5.56 vs. 32.22±8.8, p= 0.024). Conclusion: The patients' commitment to the integrative pain treatment approach was low in a setting where integrative medicine is still largely unknown. However, we noted significantly lesser pain and catastrophizing in patients who were fully committed to the program.

Keywords: Integrative medicine; phytotherapy; breathing excersises; chronic pain; catastrophizing
ÖZET
 Amaç: Kronik sırt ağrısı, çok miktarda kaynak gerektiren karmaşık, güçten düşürücü bir durumdur. Bu çalışmada, bütünleştirici tıbbın hâlâ büyük ölçüde bilinmediği bir ortamda kronik sırt ağrısı olan hastaları tedavi etmek için bütünleştirici bir ağrı yaklaşımının etkinliğini değerlendirmeyi amaçladık. Gereç ve Yöntemler: Ağrı polikliniğine başvuran ve bütüncül yaklaşımla tedavi edilen kronik bel ağrısı olan hastalar programa dâhil edildi. Program sırasında hastaların demografik ve klinik verileri ile Sayısal Derecelendirme Ölçeği [Numerical Rating Scale (NRS)], Ağrı Felaketleştirme Puanı [Pain Catastrophizing Scale (PCS)] ve Beck Anksiyete Envanteri [Beck Anxiety Inventory (BAI)] puanları gibi değerlendirme puanları program sırasında toplandı. İki ay sonra veriler dosyalardan alınarak retrospektif olarak değerlendirildi. Bulgular: Toplamda 96 hasta çalışmaya alındı. Yaş ortalamaları 46,52±13 yıldı; hastaların %82,3'ü kadındı. Hastaların bütünleştirici ağrı tedavi yaklaşımına bağlılığı zamanla kademeli olarak azaldı. Hastaların sadece %10,4'ü tüm tedavi programını tamamladı. Program sonrasında NRS ve PCS skorları anlamlı olarak azaldı (NRS: 7,75±2,21'e karşı 5,75±3,3; p=0,027; PCS: 40,22±5,56'ya karşı 32,22±8,8; p=0,024). Sonuç: Bütünleştirici tıbbın hâlâ büyük ölçüde bilinmediği bir ortamda, hastaların bütünleştirici ağrı tedavisi programına bağlılığı düşüktü. Bununla birlikte, programa tamamen bağlı olan hastalarda önemli ölçüde daha az ağrı ve ağrı felaketleştirme olduğunu gözlemledik.

Anahtar Kelimeler: Bütünleştirici tıp; fitoterapi; nefes egzersizleri; kronik ağrı; felaketleştirme
REFERENCES:
  1. Rakel DP, Weil A. Philosophy of integrative medicine. In: Rakel DP, ed. Integrative Medicine. 4th ed. Philadelphia, PA USA: Elsevier; 2018. p.1-11. [Crossref] 
  2. Saha FJ, Brüning A, Barcelona C, Büssing A, Langhorst J, Dobos G, et al. Integrative medicine for chronic pain: a cohort study using a process-outcome design in the context of a department for internal and integrative medicine. Medicine (Baltimore). 2016;95(27):e4152. [Crossref]  [PubMed]  [PMC] 
  3. Petri RP Jr. Integrative health and healing as the new health care paradigm for the military. Med Acupunct. 2015;27(5):301-8. [Crossref]  [PubMed]  [PMC] 
  4. Orhan FO, Elmas B, Altındiş S, Karagöz R, Altındiş M. Aile hekimi ve pediatristlerin geleneksel ve tamamlayıcı tıbba (GETAT) bakışı [Traditional and complementary medicine view of family physician and pediatrists]. Journal of BSHR. 2019;3:161-7. [Crossref] 
  5. American Association of Neurological Surgeons [Internet]. © 2023 American Association of Neurological Surgeons [Cited: December 12, 2020]. Spinal Pain. Available from: [Link] 
  6. Husky MM, Ferdous Farin F, Compagnone P, Fermanian C, Kovess-Masfety V. Chronic back pain and its association with quality of life in a large French population survey. Health Qual Life Outcomes. 2018;16(1):195. [Crossref]  [PubMed]  [PMC] 
  7. Mills SEE, Nicolson KP, Smith BH. Chronic pain: a review of its epidemiology and associated factors in population-based studies. Br J Anaesth. 2019;123(2):e273-e83. [Crossref]  [PubMed]  [PMC] 
  8. Andersson HI. The course of non-malignant chronic pain: a 12-year follow-up of a cohort from the general population. Eur J Pain. 2004;8(1):47-53. [Crossref]  [PubMed] 
  9. Parkin-Smith GF, Davies SJ, Amorin-Woods LG. Looking ahead: chronic spinal pain management. J Pain Res. 2017;10:2089-95. [Crossref]  [PubMed]  [PMC] 
  10. Lemmon R, Roseen EJ. Chronic low back pain. In: Rakel DP, ed. Integrative Medicine. 4th ed. Philadelphia, PA USA: Elsevier; 2018. p.662-75. [Crossref] 
  11. İlhan MN, Aksakal FN, Kaptan H, Ceyhan MN, Durukan E, İlhan F, et al. Birinci basamakta yaşam boyu bel ağrısı sıklığı ve ilişkili sosyal ve mesleksel risk etmenleri [Social and occupational factors associateed: lifetime prevalence of low back pain in primary care]. Gazi Medical Journal. 2010;21(3):107-10. [Link] 
  12. Ministry of Health [Internet]. [Cited: December 12, 2020]. Launch Meeting of GETAT 2019 in Istanbul. Available from: [Link] 
  13. Sullivan M, Bishop SR, Pivik J. The Pain Catastrophizing Scale: Development and validation. Psychological Assessment. 1995;7(4):524-32. [Crossref] 
  14. Ozsoy-Unubol T, Unal-Ulutatar C. Coss-cultural adaptation and validation of the Turkish version of Centrality of Pain Scale in patients with fibromyalgia syndrome. Int J Rheum Dis. 2020;23(6):772-7. Epub 2020 Mar 23. [Crossref]  [PubMed] 
  15. Markotic F, Cerni Obrdalj E, Zalihic A, Pehar R, Hadziosmanovic Z, Pivic G, et al. Adherence to pharmacological treatment of chronic nonmalignant pain in individuals aged 65 and older. Pain Med. 2013;14(2):247-56. [Crossref]  [PubMed] 
  16. Sandikci KB, Üstü Y, Sandikci MM, Kayhan Tetik B, Işik D, Uğurlu M. Attitudes and behaviors of physicians in dealing with difficult patientsand relatives: a cross-sectional study in two training and research hospitals. Turk J Med Sci. 2017;47(1):222-33. [Crossref]  [PubMed] 
  17. Elder N, Ricer R, Tobias B. How respected family physicians manage difficult patient encounters. J Am Board Fam Med. 2006;19(6):533-41. [Crossref]  [PubMed] 
  18. Jackson JL, Kroenke K. Difficult patient encounters in the ambulatory clinic: clinical predictors and outcomes. Arch Intern Med. 1999;159(10):1069-75. [Crossref]  [PubMed] 
  19. Leung L. Pain catastrophizing: an updated review. Indian J Psychol Med. 2012;34(3):204-17. [Crossref]  [PubMed]  [PMC] 
  20. Schütze R, Rees C, Smith A, Slater H, Campbell JM, O'Sullivan P. How can we best reduce pain catastrophizing in adults with chronic noncancer pain? A systematic review and meta-analysis. J Pain. 2018;19(3):233-56. [Crossref]  [PubMed] 
  21. Suren M, Kaya Z, Gokbakan M, Okan I, Arici S, Karaman S, et al. The role of pain catastrophizing score in the prediction of venipuncture pain severity. Pain Pract. 2014;14(3):245-51. [Crossref]  [PubMed] 
  22. Di Carlo M, Beci G, Salaffi F. Acupuncture for fibromyalgia: an open-label pragmatic study on effects on disease severity, neuropathic pain features, and pain catastrophizing. Evid Based Complement Alternat Med. 2020;2020:9869250. [Crossref]  [PubMed]  [PMC] 
  23. Van Eijsden-Besseling MD, van Attekum A, de Bie RA, Staal JB. Pain catastrophizing and lower physical fitness in a sample of computer screen workers with early non-specific upper limb disorders: a case-control study. Ind Health. 2010;48(6):818-23. [Crossref]  [PubMed] 

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