Relationship Between Patient-Reported Chronic Low Back Pain Severity and Medication Resources

Background: Anecdotal evidence indicates the possible efficacy of cannabis use as an adjunctive treatment in chronic low back pain. The purpose of the current study was to assess the results of treatment of patients suffering from chronic low back pain by medicinal cannabis (MCT). Methods: A cohort of 46 patients was followed for a minimum of twelve months. They were evaluated at baseline prior to MCT, 3 months later when MCT was begun and up to 12 months of MCT by patient reported outcome questionnaire (SF-12), visual analogue scale (VAS) and the Brief Pain Inventory (BPI), back specific function was assessed using the Oswestry score, range of motion was measured using the Saunders digital inclinometer. Opiate use was assessed using pharmacy dispensation records at baseline and after 12 months of MCT. Inclusion criteria included: age over 25 years, sciatica with documented treatment for at least 12 months, evidence on CT or MRI scan of disc herniation or spinal stenosis, failure of at least two narcotic drugs, and consent to use medicinal cannabis. Exclusion criteria included evidence of bone cancer, evidence of diabetic neuropathy, and evidence of prior psychotic reactions. Treatment protocol: Cannabis usage was at a fixed dosage of 20 grams per month, dose increase was considered at least after 6 months of treatment. The cannabis was smoked at a recommended rate of 4 dosages per day. Results: After 12 months of MCT BPI VAS decreased from 8.4 ± 1.4 to 2.0 ± 2.0; SF12-PCS improved from 47 ± 14 to 55 ± 12; SF12-MCS improved from 44 ± 6 to 50 ± 10; and sagittal plane active range of motion improved from 34º ± 8º degrees to 48º ± 8º, In conclusion, short term usage of smoked medicinal cannabis appear to improve both physical and mental function while decreasing pain levels of chronic low back pain sufferers.

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Perceived Injustice Helps Explain the Association Between Chronic Pain Stigma and Movement-Evoked Pain in Adults with Nonspecific Chronic Low Back Pain

Pain Medicine ◽

10.1093/pm/pnaa095 ◽

2020 ◽

Vol 21 (11) ◽

pp. 3161-3171

Author(s):

Terence M Penn ◽

Demario S Overstreet ◽

Edwin N Aroke ◽

Deanna D Rumble ◽

Andrew M Sims ◽

...

Keyword(s):

Chronic Pain ◽

Low Back Pain ◽

Back Pain ◽

Physical Function ◽

Indirect Effect ◽

Chronic Low Back Pain ◽

Pain Severity ◽

Low Back ◽

Perceived Injustice ◽

Objective Basis

Abstract Objective For most patients with chronic low back pain (cLBP), the cause is “nonspecific,” meaning there is no clear association between pain and identifiable pathology of the spine or associated tissues. Laypersons and providers alike are less inclined to help, feel less sympathy, dislike patients more, suspect deception, and attribute lower pain severity to patients whose pain does not have an objective basis in tissue pathology. Because of these stigmatizing responses from others, patients with cLBP may feel that their pain is particularly unjust and unfair. These pain-related injustice perceptions may subsequently contribute to greater cLBP severity. The purpose of this study was to examine whether perceived injustice helps explain the relationship between chronic pain stigma and movement-evoked pain severity among individuals with cLBP. Methods Participants included 105 patients with cLBP who completed questionnaires assessing chronic pain stigma and pain-related injustice perception, as well as a short physical performance battery for the assessment of movement-evoked pain and physical function. Results Findings revealed that perceived injustice significantly mediated the association between chronic pain stigma and cLBP severity (indirect effect = 6.64, 95% confidence interval [CI] = 2.041 to 14.913) and physical function (indirect effect = −0.401, 95% CI = −1.029 to −0.052). Greater chronic pain stigma was associated with greater perceived injustice (P = 0.001), which in turn was associated with greater movement-evoked pain severity (P = 0.003). Conclusions These results suggest that perceived injustice may be a means through which chronic pain stigma impacts nonspecific cLBP severity and physical function.

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The Relationship Between Endplate Pathology and Patient-reported Symptoms for Chronic Low Back Pain Depends on Lumbar Paraspinal Muscle Quality

Spine ◽

10.1097/brs.0000000000003035 ◽

2019 ◽

Vol 44 (14) ◽

pp. 1010-1017 ◽

Cited By ~ 8

Author(s):

Jeannie F. Bailey ◽

Aaron J. Fields ◽

Alex Ballatori ◽

Danielle Cohen ◽

Deeptee Jain ◽

...

Keyword(s):

Low Back Pain ◽

Back Pain ◽

Chronic Low Back Pain ◽

Paraspinal Muscle ◽

Muscle Quality ◽

Low Back ◽

Patient Reported ◽

The Relationship

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Effect of Comorbid Chronic Low Back Pain on Patient-Reported Outcome and Gait Parameters in Patients With Symptomatic Knee Osteoarthritis

American Journal of Physical Medicine & Rehabilitation ◽

10.1097/phm.0000000000001492 ◽

2020 ◽

Vol 99 (12) ◽

pp. 1184-1188

Author(s):

Se Won Lee ◽

Jasal Patel ◽

Ayutyanont Napatkamon ◽

Eric Aguilla ◽

Joseph Hill ◽

...

Keyword(s):

Low Back Pain ◽

Back Pain ◽

Knee Osteoarthritis ◽

Chronic Low Back Pain ◽

Patient Reported Outcome ◽

Low Back ◽

Gait Parameters ◽

Symptomatic Knee Osteoarthritis ◽

Symptomatic Knee ◽

Patient Reported

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Pharmacological target therapy of neuropathic pain and patient-reported outcomes in patients with chronic low back pain in Korea

Medicine ◽

10.1097/md.0000000000011919 ◽

2018 ◽

Vol 97 (35) ◽

pp. e11919

Author(s):

Jae Taek Hong ◽

Jin-Hwan Kim ◽

Keun-Su Kim ◽

Chong-Suh Lee ◽

Hyun-Chul Shin ◽

...

Keyword(s):

Neuropathic Pain ◽

Low Back Pain ◽

Back Pain ◽

Chronic Low Back Pain ◽

Patient Reported Outcomes ◽

Target Therapy ◽

Low Back ◽

Patient Reported ◽

Pharmacological Target

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Reverse transformation of Modic Type 2 changes to Modic Type 1 changes during sustained chronic low-back pain severity

Journal of Neurosurgery Spine ◽

10.3171/spi.2007.6.2.152 ◽

2007 ◽

Vol 6 (2) ◽

pp. 152-155 ◽

Cited By ~ 28

Author(s):

Laurence A. G. Marshman ◽

Matthew Trewhella ◽

Tai Friesem ◽

Chandra K. Bhatia ◽

Manoj Krishna

Keyword(s):

Low Back Pain ◽

Back Pain ◽

Chronic Low Back Pain ◽

Reverse Transformation ◽

Pain Severity ◽

Low Back ◽

Modic Type ◽

Generating Capacity

✓Modic Type 2 (MT2) neuroimaging changes are considered stable or invariant over time and relatively quiescent, whereas Modic Type 1 (MT1) changes are considered unstable and more symptomatic. The authors report two cases in which MT2 changes were symptomatic and evidently unstable, and in which chronic low-back pain severity remained unaltered despite a MT2–MT1 reverse transformation. Two women (41 and 48 years old) both presented with chronic low-back pain. Magnetic resonance (MR) images demonstrated degenerating discs at L5–S1 associated with well-established MT2 changes in adjacent vertebrae. Repeated MR imaging in these two patients after 11 months and 7 years, respectively, revealed reverse transformation of the MT2 changes into more florid MT1 changes, despite unaltered chronic low-back pain severity. Following anterior discectomy and disc arthroplasty, immediate abolition of chronic low-back pain was achieved in both patients and sustained at 3-year follow up. Modic Type 2 changes are therefore neither as stable nor as quiescent as originally believed. Each type can change, with equal symptom-generating capacity. More representative imaging–pathological correlates are required to determine the precise nature of MT changes.

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