scholarly journals Symptoms and signs possibly indicating segmental, discogenic pain. A fusion study with 18 years of follow-up

2017 ◽  
Vol 16 (1) ◽  
pp. 213-220 ◽  
Author(s):  
Bo Nyström ◽  
Henrik Weber ◽  
Birgitta Schillberg ◽  
Adam Taube
Keyword(s):  
Low Back Pain ◽  
Back Pain ◽  
Clinical Examination ◽  
Prospective Studies ◽  
Chronic Low Back Pain ◽  
Full Time ◽  
Low Back ◽  
Discogenic Pain ◽  
Fusion Surgery ◽  
Symptoms And Signs

AbstractBackgroundOnly two out of the five existing randomized studies have reported better results from fusion surgery for chronic low back pain (CLBP) compared to conservative treatment. In these studies the back symptoms of the patients were described simply as “chronic low back pain”. One possible reason for the modest results of surgery is the lack of a description of specified symptoms that might be related to a painful segment/disc, and patient selection may therefore be more or less a matter of chance. Previous prospective studies including facet joint injections and discography and eventually MRI have failed to identify patients with a painful segment/disc that will benefit from fusion surgery.PurposeOur purpose was to analyse in detail the pre-operative symptoms and signs presented by patients who showed substantial relief from their back pain following spinal fusion surgery with the aim of possibly finding a pain pattern indicating segmental, discogenic pain.MethodsWe analysed 40 consecutive patients, mean age 41 years, with a history of disabling low back pain for a mean of 7.7 years. Before surgery the patients completed a detailed questionnaire concerning various aspects of their back pain, and findings at clinical examination were thoroughly noted. Monosegmental posterior lumbar interbody fusion without internal fixation was performed using microsurgical technique. Outcome was assessed at 1, 2 and 4 years after surgery and finally at 18 years, using selfreporting measures and assessment by an independent examiner. Assessment at 18 years applied the Balanced Inventory for Spinal Disorders Questionnaire and the Roland-Morris Disability Questionnaire.ResultsAccording to the independent observer’s assessment at two years 27 of the 40 patients were much improved. Analysis of the pre-operative depiction of the back symptoms of this group revealed a rather uniform pattern, the most important being: dominating back pain originating in the midline of the spine, with a dull, aching character and stabbing pain in the same area provoked by sudden movements. Most patients in this group also had diffuse pain radiation of various extension down one or both legs and often bladder dysfunction with frequency. At clinical examination, localized interspinal tenderness was observed within the spinal area in question and the patient’s back pain was provoked by pressure in that area and by tapping a neighbouring spinous process.At 18 years after surgery 19 patients assessed themselves as much improved. At that time 5 of them had pension due to age, 7 early pension, one worked full time and six patients part time. Eleven patients were re-operated due to defect bony healing.ConclusionsThe results may suggest that the use of a detailed symptom analysis and clinical examination may make it possible to select a subgroup of patients within the CLBP group likely to have better outcome following fusion surgery.ImplicationsThe next step would be to execute prospective studies and if our findings concerning back pain details and signs among CLPB patients can be confirmed this can provide for more accurate selection of patients suitable for fusion surgery.

scholarly journals Effect of the duration of chronic low back pain on pain sensitivity of patients undergoing lumbar fusion surgery

Pain medicine ◽  
2021 ◽  
Vol 5 (4) ◽  
pp. 8-15
Author(s):  
Mei-ping Qian ◽  
Mei-rong Dong ◽  
Fang Kang ◽  
Juan Li
Keyword(s):  
Chronic Pain ◽  
Low Back Pain ◽  
Back Pain ◽  
Hospital Stay ◽  
Chronic Low Back Pain ◽  
Pain Sensitivity ◽  
Lumbar Fusion ◽  
Low Back ◽  
Fusion Surgery ◽  
Lumbar Fusion Surgery

Background: chronic low back pain is a serious social problem. In recent years, patients who choose lumbar fusion surgery due to chronic low back pain has been increasing. Pre-existing chronic pain has been associated with severe postoperative pain. In this study, we have sought to prospectively analyze the association between the duration of chronic low back pain and pain sensitivity after lumbar fusion surgery. Methods: 400 patients who underwent lumbar fusion surgery were divided into three groups based on the duration of chronic pain. During the first postoperative day, the maximum pain scores of each patient day and night, the pain scores at the day of discharge, the consumption of postoperative analgesics and the length of hospital stay were recorded. Results: of 400 patients recruited, 369 patients completed the experiment. There was no significant difference in gender, age, height, weight, pre-operative pain at rest, and operation time in the three groups. During the day, the pain sensitivity of the three groups were 1.71 ± 0.66, 2.40 ± 0.74, 2.90 ± 0.80. During the night, the pain sensitivity of the three groups were 3.45 ± 0.81, 4.31 ± 1.06, 4.86 ± 1.05. At the day of discharge, the pain sensitivity of three groups were 1.26 ± 0.46, 1.47 ± 0.58, 1.96 ± 0.64. There were significant differences in pain sensitivity among the three groups during the day and night on the first postoperative day and at the day of discharge (p < 0.05). The length of hospital stay (7.31 ± 1.36 days, 8.82 ± 1.48 days, 9.60 ± 1.61 days) and analgesic consumption (25.04 ± 36.56 mg, 33.52 ± 24.04 mg, 45.15 ± 24.89 mg, morphine equivalent) were also significant differences (p < 0.05). Conclusion: we found the duration of chronic low back pain before lumbar fusion surgery affects patient’ postoperative pain sensitivity, consumption of analgesic drugs and hospital stay. The longer the preoperative chronic pain lasts, the higher the postoperative VAS score is, the more analgesic drugs were consumed, and the longer hospital stay is.

scholarly journals Central Sensitisation and functioning in patients with chronic low back pain: protocol for a cross-sectional and cohort study

BMJ Open ◽  
2020 ◽  
Vol 10 (3) ◽  
pp. e031592 ◽  
Author(s):  
Jone Ansuategui Echeita ◽  
Henrica R Schiphorst Preuper ◽  
Rienk Dekker ◽  
Ilse Stuive ◽  
Hans Timmerman ◽  
...  
Keyword(s):  
Low Back Pain ◽  
Back Pain ◽  
Multiple Regression ◽  
Chronic Low Back Pain ◽  
Medical Center ◽  
Low Back ◽  
Cross Sectional ◽  
Central Sensitisation ◽  
Independent Variable ◽  
Symptoms And Signs

IntroductionA relevant subsample of patients with chronic low back pain (CLBP) have manifested augmented central pain processing, central sensitisation (CS). Patients with CLBP have limited functioning and participation. Theoretically, physical functioning in patients with CLBP can plausibly be linked to CS; however, evidence to explain such association is scarce. Moreover, there is no gold standard for CS diagnosis. The objectives of the study are: (1) to analyse the association between instruments assessing reference symptoms and signs attributed to CS; (2) to analyse whether reference symptoms and signs attributed to CS are associated with functioning measurement outcomes; and (3) to analyse whether changes (between baseline and discharge) in reference symptoms and signs attributed to CS are related to changes in each of the functioning measurement outcomes.Methods and analysisA cross-sectional and longitudinal observational study is performed with measurements taken at baseline and discharge of an interdisciplinary rehabilitation programme. A sample size of 110 adult patients with CLBP has been calculated for the study. CS measurements are: Central Sensitisation Inventory, quantitative sensory testing and heart rate variability. Functioning measurements are: lifting capacity, maximal aerobic capacity, accelerometry and reported functioning. Statistical analyses to be performed are: (1) correlation between CS measurements, (2) multiple regression between functioning (dependent variable) and CS measurements (independent variable), and (3) multiple regression between changes in scores of functioning (dependent variable) and CS measurements (independent variable), and corrected for sex and age.Ethics and disseminationThe study obtained the clearance to its implementation from the Medical Research Ethics Committee of the University Medical Center Groningen in July 2017. The results will be disseminated through scientific publications in peer-reviewed journals, presentations at relevant conferences, and reports to stakeholders.Trial registration numberNTR7167/NL6980.

Pain-drawing does not predict the outcome of fusion surgery for chronic low-back pain: a report from the Swedish Lumbar Spine Study

2003 ◽  
Vol 12 (1) ◽  
pp. 2-11 ◽  
Author(s):  
O. Hägg ◽  
P. Fritzell ◽  
R. Hedlund ◽  
H. Möller ◽  
L. Ekselius ◽  
...  
Keyword(s):  
Low Back Pain ◽  
Back Pain ◽  
Lumbar Spine ◽  
Chronic Low Back Pain ◽  
Low Back ◽  
Fusion Surgery ◽  
Pain Drawing

scholarly journals Spinal Fusion in the Treatment of Chronic Low Back Pain: Rationale for Improvement

2012 ◽  
Vol 6 (1) ◽  
pp. 478-481 ◽  
Author(s):  
Bo Nyström
Keyword(s):  
Low Back Pain ◽  
Back Pain ◽  
Spinal Fusion ◽  
Chronic Low Back Pain ◽  
Low Back ◽  
Radiological Findings ◽  
Discogenic Pain ◽  
Reliable Test ◽  
Motion Segment

Results following fusion for chronic low back pain (CLBP) are unpredictable and generally not very satisfying. The major reason is the absence of a detailed description of the symptoms of patients with pain, if present, in a motion segment of the spine. Various radiological findings have been attributed to discogenic pain, but if these radiological signs were really true signs of such pain, fusion would have been very successful. If discogenic pain exists, it should be possible to select these patients from all others within the CLBP population. Even if this selection were 100% perfect, however, identification of the painful segment would remain, and at present there is no reliable test for doing so. Regardless of whether an anterior or posterior type of fusion is performed, or even if artificial discs are used, solving the puzzle of pain associated with the presumed segmental disorder must be the primary goal.

Work Hardening: Evidence for Success of a Program

1995 ◽  
Vol 77 (3_suppl) ◽  
pp. 1077-1078
Author(s):  
Stacey A. Ricke ◽  
Paul J. Chara ◽  
Mary M. Johnson
Keyword(s):  
Low Back Pain ◽  
Back Pain ◽  
Return To Work ◽  
Chronic Low Back Pain ◽  
Work Hardening ◽  
Full Time ◽  
Low Back ◽  
Physical Strength ◽  
Telephone Calls

The effectiveness of a work hardening program in facilitating gains in physical strength and return to work in 40 chronic low back-pain clients was assessed. Statistically significant gains in physical strength were found. Also, 27 of the 32 clients reached by follow-up telephone calls returned to work full time.

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