How Multimodal Rehabilitation Can Alleviate Chronic Low Back Pain

Pain is more than just physical

Almost 65 million Americans experience back pain with 16 million reporting consistent or chronic pain that limits their everyday activities.⁸ Back pain alone incurs over $12 billion per year in both direct and indirect healthcare costs, including missed work days and disability payments.⁸ Over four million adults report that they have had difficulties becoming or remaining employed due to back pain, and those suffering from chronic back pain reportedly earn substantially less due to the work limitations brought on by their condition.⁸

To treat these conditions, many people rely on pain medication, physical therapy (when they have access to it), and, in more severe cases, surgery. But treating chronic low back pain at the physical level only fails to address the physical, psychological, and social factors that contribute to pain, known together as biopsychosocial factors. To more effectively address low back pain, many healthcare and benefits providers are leaning into a “whole-person” approach that takes all three biopsychosocial factors into account.

Three bio-psycho-social pain factors

Biological: This includes everything in the body, from molecules and DNA to the internal organs and nervous system.

Psychological: This includes personality, behaviors, learning and coping skills, emotions, and overall mental health.

Social: This includes all relationships (eg, with family, friends, coworkers, and social support network), as well as environmental influences like cultural background and education.

A person’s thoughts, emotions, behaviors, beliefs, living situation, relationships, and family dynamics can also influence low back pain.² Studies have shown that a combination of workplace stress, faltering quality of life, depression, anxiety, or worry can even increase the risk of acute pain becoming chronic.⁷

What is multimodal rehabilitation?

Multimodal rehabilitation (MMR) is a holistic, “whole person” approach that integrates various therapies – including physical exercises, psychological interventions, and social support – to address chronic low back pain comprehensively.³ When executed properly, MMR has the potential to:

• Improve a person’s ability to function in everyday life
• Create their own pain-management strategies⁶
• Prevent acute pain from developing into chronic pain

Traditional MMR draws upon the skills of a dedicated team of different healthcare professionals who work closely together to coordinate treatment.⁵ For example, a person receiving MMR may simultaneously see a physician, physical therapist, psychologist, and even yoga and meditation instructors. This approach has become the gold standard for back pain in Europe⁴, and has been steadily gaining traction in the United States where the American College of Physicians recommends patients try MMR before medication in its treatment guidelines for low back pain.¹

Benefits of multimodal rehabilitation

In studies, MMR has demonstrated some impressive benefits over conventional low back pain treatments. In a review of 41 clinical trials of MMR for chronic low back pain, researchers found the following:

• MMR was more effective at decreasing pain and disability than the usual care for low back pain.³
• MMR participants were more likely to return to work than people who only received physical treatment.³
• MMR participants saw similar outcomes as people who opted for surgery to treat their back pain, but were less likely to experience adverse events.³

Kaia Health’s multimodal approach to musculoskeletal therapy

Kaia’s pain management therapies are based on an MMR approach, incorporating physical exercises, relaxation practices, and educational content that are available through the mobile app anytime, anywhere. Users also benefit from 1:1 access to Kaia Health Coaches and Physical Therapists (PTs), as well as Motion Coachᵀᴹ which uses computer vision technology to provide real-time form feedback, and progress tracking.

This convenience and ease of use enables users to complete exercise sessions and address their various bio-psycho-social pain triggers to achieve comprehensive and long-lasting results without the need for appointments, wait times, or long commutes to in-person clinics.

Multimodal Rehabilitation improves outcomes and lowers costs

MMR offers a cost-effective solution for managing chronic low back pain compared to traditional treatments or surgical interventions by preventing unnecessary medical procedures and reducing reliance on long-term medication. Employees’ quicker return to work and reduced absenteeism due to chronic pain also contributes to a more productive workforce and lower healthcare-related expenses over time.

By embracing multimodal rehabilitation as a leading-edge approach to chronic low back pain, employers and health plan payers can enhance employee health outcomes, reduce healthcare costs, and foster a more supportive and competitive workplace environment. Investing in comprehensive care that addresses bio-psycho-social factors not only benefits individual employees but also promotes organizational success and sustainability in the long run.

To learn more about how Kaia can improve population outcomes and lower costs for your organization, visit www.kaiahealth.com 

References

1. Qaseem A, Wilt TJ, McLean RM, Forceia MA; Clinical Guidelines Committee of the American College of Physicians. Noninvasive treatments for acute, subacute, and chronic low back pain: a clinical practice guideline from the American College of Physicians. Ann Intern Med. 2017;166(7):514-530.
2. Physiopedia. Biopsychosocial model. Physiopedia website. https://www.physio-pedia.com/Biopsychosocial_Model. Accessed April 29, 2019.
3. Kamper SJ, Apeldoorn AT, Chiarotto A, et al. Multidisciplinary biopsychosocial rehabilitation for chronic low back pain: Cochrane systematic review and meta-analysis. BMJ. 2015;350:h444.
4. Böger A. Multimodal pain therapy [in German]. Versicherungsmedizin. 2014;66(2):72-78.
5. Morlion B, Pergolizzi J, Huygen F. The burden of chronic noncancer pain. In: Pergolizzi J, ed. Towards a Multidisciplinary Approach in Chronic
   Pain Management. https://www.pae-eu.eu/wp-content/uploads/2013/12/Multidisciplinary-approach-in-chronic-pain-management.pdf. Published 2011. Accessed April 29, 2019.
6. Schütze A, Kaiser U, Ettrich U, et al. Evaluation of a multimodal pain therapy at the University Pain Centre Dresden [in German]. Der Schmerz. 2009;23(6):609-617.
7. Koes BW, van Tulder MW, Thomas S. Diagnosis and treatment of low back pain. BMJ. 2006;332(7555):1430-1434.
8. Health Policy Institute. Chronic Back Pain. Georgetown University