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Self-Service for Back Pain

Nursing professor Jennifer Kawi is investigating how self-care strategies might help those suffering from chronic back pain.

Research  |  Feb 3, 2015  |  By Kevin Dunegan
Jennifer Kawi poses next to three skeletons

Nursing professor Jennifer Kawi. (Aaron Mayes / UNLV Photo Services)

When it comes to painful conditions affecting the mobility of millions of Americans, bum knees take a back seat to bad backs. Chronic low-back pain is the most common health complaint in the United States, afflicting nearly 30 percent of people older than 18. In addition to the physical discomfort it causes, chronic low-back pain sufferers also incur high health care costs.

In recent years, more physicians and specialists have recommended self-management strategies to help reduce pain, improve quality of life, and lower associated treatment costs. Jennifer Kawi, a chronic pain specialist and assistant professor in the School of Nursing, is among those who have noted its effectiveness, and she is currently working to identify those chronic low-back pain sufferers who might benefit.

In general, self-management strategies not only encourage patients to actively direct and improve their health, but they also inspire and reinforce patient confidence. Such positive feelings, Kawi says, help patients set realistic goals and action plans, and make lifestyle changes that often include increased exercise and activity levels, better eating habits, and greater use of non-pharmacological pain remedies such as heating wraps and relaxation techniques.

While self-management has improved outcomes and lowered health care costs for a host of conditions, its effectiveness with chronic low-back pain sufferers has not been fully explored. Kawi's project aimed to remedy this using a two-pronged approach.

She first sought to identify variables, such as perceived support from health care providers, pain intensity, and functional ability, that might predict which low-back pain sufferers would respond best to self-management strategies. Her second goal involved evaluating differences in those variables among patients seeking help in specialty pain centers and primary care clinics. Understanding these variables, she reasoned, could help maximize self-management effectiveness in clinical settings, while enabling health care providers to tailor self-management strategies to fit the needs of individual patients.

Kawi and her team analyzed data from 230 people with chronic low-back pain -- 110 from specialty pain centers and 120 from primary care clinics. Her research revealed five variables to be predictors of self-management for patients in both settings: age, self-management support, education levels, overall health, and the helpfulness of pain management.

She also discovered differences among key variables in patients who sought care from a specialty pain center versus those who sought care in a primary care clinic. For example, participants in specialty pain centers were more apt to self-manage if they were active in their religious or spiritual beliefs or if they received support from their significant others. On the other hand, low-back pain patients in primary care clinics who had higher incomes tended to self-manage more than those with lower incomes. These important preliminary findings have been tabbed for future research.

Kawi's research has already provided essential intervention data that health care providers can use to bolster the odds that chronic low-back pain patients will be able to successfully self-manage their conditions. The results also identified a need to formulate additional strategies for patients who may not be the best candidates for self-management programs.

The study, which was funded by an external grant from the Nurse Practitioner Healthcare Foundation, appeared in the journal Applied Nursing Research.