Predictors of Self-Management for Chronic Low Back Pain

Sunday, 27 July 2014: 1:15 PM

Jennifer Kawi, PhD, MSN, APRN, FNP-BC
School of Nursing, Physiological Department, University of Nevada, Las Vegas, Las Vegas, NV

Purpose: This research study aimed to: (a) identify variables that best predict self-management (SM) of chronic low back pain (CLBP), and (b) evaluate differences in these variables between individuals in specialty pain centers and primary care clinics.

     CLBP is a continuous or intermittent discomfort persisting for at least three months. It affects about 10% of the world population and is becoming increasingly prevalent. Globally, the ranking of CLBP increased from being the 12th leading cause of years of life lost and years lived with disability in 1990, to number 7 in 2010 (Murray & Lopez, 2013). SM strategies are strongly recommended internationally and in several chronic pain care guidelines to help address the major health and economic challenges in this patient population. SM is described as the performance of tasks and skills with self-efficacy to activate individuals in making appropriate decisions and engage in health-promoting behaviors (Lorig & Holman, 2003). SM has been shown to improve health outcomes in several chronic illnesses. However, the evidence of SM effectiveness in CLBP remains unclear. It is likely that SM programs are most effective only in certain subgroups of the chronic pain population. Hence, it is essential to identify variables that best predict SM in CLBP.

Methods: This research study is a secondary analysis of data collected from two previous CLBP research studies in specialty pain centers and primary care clinics (N = 230). These two studies described several pain and patient-related variables in adults with non-malignant CLBP but did not address the predictors of SM. Descriptive statistics and general linear modeling were conducted for data analysis.

Results: Overall, five variables were found to be significant predictors of SM: age, education, overall health, SM support, and helpfulness of pain management. Those who were younger, had higher educational level, had better overall health, perceived more support from their healthcare providers, and perceived benefits from their pain management modalities were more likely to respond to SM. In specialty pain centers, SM support, support received from other than healthcare providers, religion or spirituality, and overall health were identified as significant predictors of SM. In primary care clinics, income, overall health, and SM support were significant predictors of SM.

Conclusion: Findings provide essential information to healthcare providers in intervening appropriately toward engaging CLBP patients in SM. Promoting healthy living through effective SM despite CLBP is a vital component of care since overall health has been consistently identified as a significant predictor of SM. Further, since nurses are in the forefront of chronic pain care, increasing our knowledge and skills in providing SM support is necessary. Adequate evaluation of individual’s willingness and abilities to engage in SM, addressing psychosocial concerns that impact SM and pain, and advocating for healthcare system changes to increase availability of chronic pain care resources in the community are all essential considerations to enhance effective SM. Interprofessional collaboration is equally important to facilitate comprehensive management of the complexity of CLBP. Consequently, other strategies need to be identified for those who do not respond adequately to SM strategies.