Management of a patient with chronic low back pain and multiple health conditions using a pain mechanisms-based classification approach

TTSTUDY DESIGN: Case report. TTBACKGROUND: Pain can lead to a significant reduction in quality of life. A pain mechanisms- based classification scheme has been outlined to improve management of patients with pain, but studies describing its use are limited. Evidence for physical therapy interventions in those with chronic pain and multiple health conditions is also lacking. This case report describes management of a patient with chronic pain and multiple health conditions. TTCASE DESCRIPTION: A 29-year-old man presented with a 3-year history of low back pain and 11-month history of lower extremity paresthesia. Current health conditions included left-sided hemiparesis secondary to a stroke, pancreatic kidney transplant, left-sided blindness, and osteoporosis secondary to hyperparathyroidism. Inability to walk to school, sit through class, and pain-related sleep disruption were the primary activity and participation restrictions. Outcome measures included the numeric pain rating scale, global rating of change, Oswestry Disability Index, and pain medication usage. A score of 12 on the Leeds assessment of neuropathic symptoms and signs (LANSS) pain scale indicated the presence of neuropathic pain, but other pain mechanisms were also hypothesized to be present. A plan of treatment was designed to improve patient goals considering these pain mechanisms. TTOUTCOMES: The patient was seen for 20 visits over 6 months. Ten months after the initial evaluation, the patient's Oswestry Disability Index scores improved by more than 50% and the patient achieved all initially stated goals without pain medication. TTDISCUSSION: A pain mechanisms-based approach assisted in the management of a patient with chronic pain and multiple health conditions. Using this approach may enhance clinical decision making when managing individuals with chronic pain.LEVEL OF EVIDENCE: Therapy, level 4.