Articles: acute-pain.
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Reg Anesth Pain Med · Feb 2022
Agents of change: the Gaston Labat awardees past, present, and future-the 2021 Gaston Labat Award lecture.
The prior recipients of the Gaston Labat Award can be thought of as change agents because of their driving desire to challenge and improve the status quo. All of us are interconnected and should seek to collectively work toward meaningful change in our communities. The 2021 Gaston Labat lecture pays tribute to past agents of change and inspires those to come by urging everyone to become involved in the solution.
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Randomized Controlled Trial
Producing clinically meaningful reductions in disability: A causal mediation analysis of a patient education intervention.
Patient education is recommended as first-line care for low back pain (LBP), although its efficacy for providing clinically meaningful reductions in disability has been questioned. One way to improve treatment effects is to identify and improve targeting of treatment mechanisms. We conducted a pre-planned causal mediation analysis of a randomized, placebo-controlled trial investigating the effectiveness of patient education for patients with acute LBP. 202 patients who had fewer than six-weeks' duration of LBP and were at high-risk of developing chronic LBP completed two, one-hour treatment sessions of either intensive patient education, or placebo patient education. 189 participants provided data for the outcome self-reported disability at three-months and the mediators, pain self-efficacy, pain catastrophizing, and back beliefs at one-week post treatment. ⋯ Considering the mediator-outcome relationship, patient education would need to induce an 8 point difference on the pain self-efficacy questionnaire (0-60); an 11 point difference on the back beliefs questionnaire (9-45); and a 21 point difference on the pain catastrophizing scale (0-52) to achieve a minimally clinically important difference of 2 points on the Roland Morris Disability Questionnaire (0-24). PERSPECTIVE: Understanding the mechanisms of patient education can inform how this treatment can be adapted to provide clinically meaningful reductions in disability. Our findings suggest that adapting patient education to better target back beliefs and pain self-efficacy could result in clinically meaningful reductions in disability whereas the role of pain catastrophizing in acute LBP is less clear.