Prospective Study of a Lumbar Back Brace In an Interventional Pain Practice
Low back pain (LBP) is a frequent problem in industrialized countries and is the second most common reason for visits to physicians.1,2 Approximately 70% to 85% of adults have suffered or currently suffer from LBP, and its prevalence continues to rise.1 In any given year, 15% to 45% of the population will experience an episode of LBP, with the incidence increasing in older adults up to age 65.1
Although the duration of most LBP episodes is usually brief (1-2 weeks), recurrent symptoms are common.3 Among patients who report recurring problems, symptoms often resolve spontaneously, many times without any intervention. However, many patients suffer from prolonged symptoms that do not resolve quickly. Some authors have reported that between 10% and 33% of patients report persistent pain after 1 year.3 Within this group, recovery is often protracted, and their treatment accounts for a majority of the spending on the problem. This segment of patients makes up a large portion of individuals on work disability.
Lumbar supports have been used in the workplace to treat LBP and to prevent strains. They also are used in primary care to reduce pain and improve mobility.1 Although interventional pain physicians routinely see patients with LBP, lumbar supports are not a common part of most of their treatment plans. This may be due to the widely held notion that a lumbar support might result in atrophy of already weakened core muscles. Research does not definitively support this position.4-6 One study even reported an increase in muscle strength after the brace was worn for 6 weeks.6 The authors acknowledged that the brace itself likely did not affect muscle fiber size, but rather that the patients’ reduced pain allowed greater mobility, thereby encouraging increased strength and flexibility.
Previous studies demonstrate that use of a lumbar support can be a viable and helpful method of improving back pain symptoms. One recent multicenter, randomized controlled trial measured three outcome measures for patients wearing an elastic lumbar support: pain level, function, and medication use. Patients in the treatment group showed improvement in all three areas, and the authors concluded that back bracing is an effective treatment option for LBP.2
Bridge to Pain Relief
Most patients seeking treatment from a pain management specialist have experienced pain for upwards of 1 year. By the time they present to a pain clinic, their pain has generally caused them significant distress, and they are seeking rapid intervention to alleviate their symptoms. However, fully understanding each patient’s unique situation with diagnostic tools such as injections and planning the appropriate course of treatment to produce long-lasting, definitive results can take several weeks. Even after treatment is performed, patients may not benefit for several weeks. For example, a physician may perform one or two medial branch nerve blocks prior to proceeding with radiofrequency (RF) nerve ablation. However, the patient may not experience the full benefit of the RF procedure for up to 4 weeks. Opiates are an option for providing relief during this period, but they come with certain risks, and many patients are already using them with unsatisfactory outcomes or with side effects. For this purpose, we undertook a study to determine if back bracing was a reliable means of providing immediate relief from LBP.
This study was conducted to confirm the results of the trial mentioned above and to determine if bracing could provide a reliable means to deliver immediate relief to patients with severe and chronic pain. We hoped to find a nonpharmacologic treatment option that could be offered during the initial evaluation and would improve function while reducing disability levels.
Patients with lumbar pain above the L5 level were asked to participate in the study. Exclusion criteria are listed in Table 1. Nineteen consecutive patients participated in the study (8 men and 11 women) with an average age of 50.3 years (range, 22-74 years). The average duration of their symptoms was 8.89 years (range, 0.3-31 years).
Upon enrolling in the study, patients were asked to rate their pain using a visual analog scale (VAS) and to fill out the Roland Morris Disability Questionnaire (RMDQ) before receiving a brace. Patients were then fitted with a brace and instructed to wear it when their pain was severe or when they planned on performing an activity that normally caused an increase in pain.
Immediately after donning the brace in the clinic, patients were asked to rate their pain again on the VAS. After 5 days, the patients again completed the RMDQ and were asked to again rate their pain on the VAS scale.
In addition to tracking VAS pain scores and RMDQ results, patients also were asked to track how much time they spent wearing the device. In addition, we asked them to rate their overall satisfaction (very satisfied, satisfied, dissatisfied, provided no value) with the device and whether or not they would recommend it to a friend with back pain.
The device we selected to use (BackJack, Cropper Medical) has a semi-rigid lumbar panel with soft, nonelastic panels around the front and sides. Patients use a cinching mechanism to draw the lumbar panel against the spine. This device was selected because it provides firm lumbar support with a semi-rigid lumbar panel while still allowing patients the mobility necessary to maintain core strength.
Patients reported wearing the device for an average of 2.28 hours per day (range, 0.6-5.2 hours). Patients’ average VAS pain score dropped by 41.2% (from 7.16 to 4.21) immediately upon donning the device and dropped slightly further (to 4.11) by the end of the study period. The average RMDQ score dropped by 40% (from 16.3 to 9.79). The detailed results of the two main areas of study are listed in Tables 2 to 4, with the overall results listed in Table 5.
In addition to the positive results from the two main areas of study, patient surveys revealed that 95% (18 of 19) of the patients were either satisfied or very satisfied with the device (42% very satisfied, 53% satisfied). One patient was dissatisfied. In addition, 95% said that they would recommend the device to a friend with back pain.
The BackJack back brace is a uniquely designed device for use by patients with both acute and chronic pain. It allows reasonable flexibility but does restrict trunk motion for flexion-extension and lateral bending movements, which is one of the ways that these devices may work to prevent LBP.7