scholarly journals Low somatosensory cortex excitability in the acute stage of low back pain causes chronic pain

2021 ◽  
Author(s):  
Luke C Jenkins ◽  
Wei-Ju Chang ◽  
Valentina Buscemi ◽  
Matthew Liston ◽  
Patrick Skippen ◽  
...  
Keyword(s):  
Chronic Pain ◽  
Low Back Pain ◽  
Back Pain ◽  
Somatosensory Cortex ◽  
Acute Stage ◽  
Low Back ◽  
Unmeasured Confounding ◽  
Corticomotor Excitability ◽  
Confounder Adjustment

ABSTRACTBACKGROUNDDetermining the mechanistic causes of complex biopsychosocial health conditions such as low back pain (LBP) is challenging, and research is scarce. Cross-sectional studies demonstrate altered excitability and organisation of the primary somatosensory and primary motor cortex in people with acute and chronic LBP, however, no study has explored these mechanisms longitudinally or attempted to draw causal inferences.METHODSProspective, longitudinal, cohort study including 120 people with an acute episode of LBP. Sensory evoked potential area measurements were used to assess primary and secondary somatosensory cortex excitability. Transcranial magnetic stimulation derived map volume was used to assess corticomotor excitability. Directed acyclic graphs identified variables potentially confounding the exposure-outcome relationship. The effect of acute-stage sensorimotor cortex excitability on six-month LBP outcome was estimated using multivariable regression modelling, with adjusted and unadjusted estimates reported. Sensitivity analyses were performed to explore the effect of unmeasured confounding and missing data.RESULTSLower primary (OR = 2.08, 95% CI = 1.22 to 3.57) and secondary (OR = 2.56, 95% CI = 1.37 to 4.76) somatosensory cortex excitability in the acute stage of LBP increased the odds of developing chronic pain at six-month follow-up. This finding was robust to confounder adjustment and unmeasured confounding (E-Value = 2.24 & 2.58, respectively). Corticomotor excitability in the acute stage of LBP was associated with higher pain intensity at 6-month follow-up (B = −0.15, 95% CI: −0.28 to −0.02) but this association did not remain after confounder adjustment.CONCLUSIONThese data provide the first evidence that low somatosensory cortex excitability in the acute stage of LBP is a cause of chronic pain. Interventions designed to increase somatosensory cortex excitability in acute LBP may be relevant to the prevention of chronic pain.

scholarly journals Low somatosensory cortex excitability in the acute stage of low back pain causes chronic pain

2021 ◽  
Author(s):  
Luke C Jenkins ◽  
Wei-Ju Chang ◽  
Valentina Buscemi ◽  
Matthew Liston ◽  
Patrick Skippen ◽  
...  
Keyword(s):  
Chronic Pain ◽  
Low Back Pain ◽  
Back Pain ◽  
Somatosensory Cortex ◽  
Acute Stage ◽  
Low Back

Multidisciplinary treatment of chronic pain: long-term follow-up of low-back pain patients ★

Pain ◽  
1977 ◽  
Vol 4 (Supp C) ◽  
pp. 283-292 ◽  
Author(s):  
Richard I. Newman ◽  
Joel L. Seres ◽  
Leonard P. Yospe ◽  
Bonnie Garlington
Keyword(s):  
Chronic Pain ◽  
Low Back Pain ◽  
Back Pain ◽  
Multidisciplinary Treatment ◽  
Low Back ◽  
Long Term Follow Up ◽  
Pain Patients

PERCUTANEOUS EPIDURAL NEUROPLASTY (PEN) USING COMBINATION OF HYALURONIDASE AND HYPERTONIC SALINE (NaCl 3%) IN TREATING FAILED BACK SURGERY SYNDROME

2018 ◽  
Vol 1 (1) ◽  
pp. 1
Author(s):  
Wawan Mulyawan ◽  
Yudi Yuwono Wiwoho ◽  
Syaiful Ichwan
Keyword(s):  
Low Back Pain ◽  
Back Pain ◽  
Hypertonic Saline ◽  
Failed Back Surgery Syndrome ◽  
Favourable Outcome ◽  
Lumbar Spine Surgery ◽  
Low Back ◽  
Failed Back Surgery ◽  
Scale Scores

Background: Following surgical treatments for low back pain, lower extremity pain or neurologic symptoms would last or recur, this is defined as failed sack surgery syndrome (FBSS). FBSS usually occurs in 5-40% of these surgical patients. The most common cause is an epidural scar adhesion. Percutaneous epidural neuroplasty is the non-mechanical treatment for this condition. Previously, the use of hyaluronidase and hypertonic saline separately is commonly used for epidurolysis but the combination of hyaluronidase and hypertonic saline 3% has not been explored.Objective: To investigate the two-year outcomes of percutaneous epidural neuroplasty using a combination of hyaluronidase and hypertonic saline 3% in patients with FBSS.Methods: Twelve patients who experience low back pain, with or without radiculopathy, who have underwent lumbar spine surgery previously were assigned to the study. Parameters, such as the visual analogue scale scores for the back (VAS-B) and legs (VAS-L), and the Oswestry disability index (ODI), were recorded and compared between pretreatment, 1 week, 1 month, 3 months, 1 year and 2 years follow-up.Results: For all 12 patients, the postoperative VAS-B, VAS-L, and ODI were significantly different from the preoperative values in all follow-up periods: 1 month, 3 months, 1 year, and 2 years.Conclusion: Based off this study group, percutaneous epidural neuroplasty using a combination of hyaluronidase and hypertonic saline 3% has a favourable outcome in the 2 years follow-up

scholarly journals Brain-Derived Neurotrophic Factor and Immune Cells in Osteoarthritis, Chronic Low Back Pain, and Chronic Widespread Pain Patients: Association with Anxiety and Depression

Medicina ◽  
2021 ◽  
Vol 57 (4) ◽  
pp. 327
Author(s):  
Dominique Josephine Dimmek ◽  
Christoph Korallus ◽  
Sabine Buyny ◽  
Gutenbrunner Christoph ◽  
Ralf Lichtinghagen ◽  
...  
Keyword(s):  
Chronic Pain ◽  
Low Back Pain ◽  
Back Pain ◽  
Immune Cells ◽  
Chronic Widespread Pain ◽  
Anxiety And Depression ◽  
Low Back ◽  
Widespread Pain ◽  
Chronic Pain Patients ◽  
Pain Patients

Background and Objectives: Musculoskeletal dysfunction can induce several types of chronic pain syndromes. It is of particular interest to elucidate the pathomechanism of different forms of chronic pain. It is possible that patients who have developed chronic widespread pain (CWP) may endure different pathomechanisms as compared to those who suffer from local pain (osteoarthritis, OA) and regional pain (chronic low back pain, cLBP), especially with regard to pain regulation and its related biomediators. The aim of this study was to determine the differences in pathomechanisms among these patients by measuring pain-related biomediators, particularly brain-derived neurotrophic factor (BDNF). Additionally, subpopulations of immune cells were determined in parallel. Materials and Methods: Patients and healthy subjects (HSs) were recruited (age and gender-matched). BDNF was measured from serum samples of patients and HSs and the data of body composition parameters were recorded. Additionally, both patients and HSs were asked to fill in questionnaires related to pain intensity, anxiety, and depression. Results: Our results highlight that the levels of both free and total BDNF are significantly lower in pain patients compared to HSs, with p values of 0.041 and 0.024, respectively. The number of CD3− CD56bright natural killer (NK) cells shows significant differences between the groups. Comparing all chronic pain patients with HSs reveals a significantly lower number of CD4+ CD8+ T cells (p = 0.031), CD3− CD56bright NK cells (p = 0.049) and CD20+ CD3− cells (p = 0.007). Conclusions: To conclude, it seems that a general conformity between the pathomechanisms of different chronic pain diseases exists, although there are unique findings only in specific chronic pain patients.

scholarly journals Estimating the population health burden of musculoskeletal conditions using primary care electronic health records

Rheumatology ◽  
2021 ◽  
Author(s):  
Dahai Yu ◽  
George Peat ◽  
Kelvin P Jordan ◽  
James Bailey ◽  
Daniel Prieto-Alhambra ◽  
...  
Keyword(s):  
Primary Care ◽  
Chronic Pain ◽  
Low Back Pain ◽  
Back Pain ◽  
Electronic Health Records ◽  
High Impact ◽  
Low Back ◽  
Musculoskeletal Health ◽  
Health Records ◽  
Electronic Health

Abstract Objectives Better indicators from affordable, sustainable data sources are needed to monitor population burden of musculoskeletal conditions. We propose five indicators of musculoskeletal health and assessed if routinely available primary care electronic health records (EHR) can estimate population levels in musculoskeletal consulters. Methods We collected validated patient-reported measures of pain experience, function and health status through a local survey of adults (≥35 years) presenting to English general practices over 12 months for low back pain, shoulder pain, osteoarthritis and other regional musculoskeletal disorders. Using EHR data we derived and validated models for estimating population levels of five self-reported indicators: prevalence of high impact chronic pain, overall musculoskeletal health (based on Musculoskeletal Health Questionnaire), quality of life (based on EuroQoL health utility measure), and prevalence of moderate-to-severe low back pain and moderate-to-severe shoulder pain. We applied models to a national EHR database (Clinical Practice Research Datalink) to obtain national estimates of each indicator for three successive years. Results The optimal models included recorded demographics, deprivation, consultation frequency, analgesic and antidepressant prescriptions, and multimorbidity. Applying models to national EHR, we estimated that 31.9% of adults (≥35 years) presenting with non-inflammatory musculoskeletal disorders in England in 2016/17 experienced high impact chronic pain. Estimated population health levels were worse in women, older aged and those in the most deprived neighbourhoods, and changed little over 3 years. Conclusion National and subnational estimates for a range of subjective indicators of non-inflammatory musculoskeletal health conditions can be obtained using information from routine electronic health records.

scholarly journals Prognosis and Course of Disability in Patients With Chronic Nonspecific Low Back Pain: A 5- and 12-Month Follow-up Cohort Study

2013 ◽  
Vol 93 (12) ◽  
pp. 1603-1614 ◽  
Author(s):  
Karin Verkerk ◽  
Pim A.J. Luijsterburg ◽  
Martijn W. Heymans ◽  
Inge Ronchetti ◽  
Annelies L. Pool-Goudzwaard ◽  
...  
Keyword(s):  
Cohort Study ◽  
Low Back Pain ◽  
Prognostic Factors ◽  
Back Pain ◽  
Short Form ◽  
Low Back ◽  
Multidisciplinary Therapy ◽  
Patient Reported ◽  
Specific Disability

Background Few data are available on the course of and predictors for disability in patients with chronic nonspecific low back pain (CNSLBP). Objective The purpose of this study was to describe the course of disability and identify clinically important prognostic factors of low-back-pain–specific disability in patients with CNSLBP receiving multidisciplinary therapy. Design A prospective cohort study was conducted. Methods A total of 1,760 patients with CNSLBP who received multidisciplinary therapy were evaluated for their course of disability and prognostic factors at baseline and at 2-, 5-, and 12-month follow-ups. Recovery was defined as 30% reduction in low back pain–specific disability at follow-up compared with baseline and as absolute recovery if the score on the Quebec Back Pain Disability Scale (QBPDS) was ≤20 points at follow-up. Potential prognostic factors were identified using multivariable logistic regression analysis. Results Mean patient-reported disability scores on the QBPDS ranged from 51.7 (SD=15.6) at baseline to 31.7 (SD=15.2), 31.1 (SD=18.2), and 29.1 (SD=20.0) at 2, 5, and 12 months, respectively. The prognostic factors identified for recovery at 5 and 12 months were younger age and high scores on disability and on the 36-Item Short-Form Health Survey (SF-36) (Physical and Mental Component Summaries) at baseline. In addition, at 5-month follow-up, a shorter duration of complaints was a positive predictor, and having no comorbidity and less pain at baseline were additional predictors at 12-month follow-up. Limitations Missing values at 5- and 12-month follow-ups were 11.1% and 45.2%, respectively. Conclusion After multidisciplinary treatment, the course of disability in patients with CNSLBP continued to decline over a 12-month period. At 5- and 12-month follow-ups, prognostic factors were identified for a clinically relevant decrease in disability scores on the QBPDS.

scholarly journals Evaluation of the EQ-5D-3L and 5L versions in low back pain patients

2021 ◽  
Vol 19 (1) ◽  
Author(s):  
A. M. Garratt ◽  
H. Furunes ◽  
C. Hellum ◽  
T. Solberg ◽  
J. I. Brox ◽  
...  
Keyword(s):  
Low Back Pain ◽  
Back Pain ◽  
Missing Data ◽  
Measurement Properties ◽  
Low Back ◽  
Improve Measurement ◽  
Multicenter Randomized Controlled Trial ◽  
Patient Reported ◽  
Ceiling Effects

Abstract Background The EuroQol EQ-5D is one of the most widely researched and applied patient-reported outcome measures worldwide. The original EQ-5D-3L and more recent EQ-5D-5L include three and five response categories respectively. Evidence from healthy and sick populations shows that the additional two response categories improve measurement properties but there has not been a concurrent comparison of the two versions in patients with low back pain (LBP). Methods LBP patients taking part in a multicenter randomized controlled trial of lumbar total disc replacement and conservative treatment completed the EQ-5D-3L and 5L in an eight-year follow-up questionnaire. The 3L and 5L were assessed for aspects of data quality including missing data, floor and ceiling effects, response consistency, and based on a priori hypotheses, associations with the Oswestry Disability Index (ODI), Pain-Visual Analogue Scales and Hopkins Symptom Checklist (HSCL-25). Results At the eight-year follow-up, 151 (87%) patients were available and 146 completed both the 3L and 5L. Levels of missing data were the same for the two versions. Compared to the EQ-5D-5L, the 3L had significantly higher floor (pain discomfort) and ceiling effects (mobility, self-care, pain/discomfort, anxiety/depression). For these patients the EQ-5D-5L described 73 health states compared to 28 for the 3L. Shannon’s indices showed the 5L outperformed the 3L in tests of classification efficiency. Correlations with the ODI, Pain-VAS and HSCL-25 were largely as hypothesized, the 5L having slightly higher correlations than the 3L. Conclusion The EQ-5D assesses important aspect of health in LBP patients and the 5L improves upon the 3L in this respect. The EQ-5D-5L is recommended in preference to the 3L version, however, further testing in other back pain populations together with additional measurement properties, including responsiveness to change, is recommended. Trial registration: retrospectively registered: https://clinicaltrials.gov/ct2/show/NCT01704677.

scholarly journals A Novel Placement Technique of S2 Screw (from S2 to Promontorium) and Double Screwing from S2

2021 ◽  
Author(s):  
Sedat Dalbayrak ◽  
Ahmet Öğrenci ◽  
Ezgi Akar ◽  
Orkun Koban ◽  
Mesut Yılmaz
Keyword(s):  
Low Back Pain ◽  
Back Pain ◽  
Revision Surgery ◽  
Chronic Low Back Pain ◽  
Screw Placement ◽  
Low Back ◽  
Screw Loosening ◽  
Dynamic Instrumentation ◽  
Placement Technique

AbstractSince pseudoarthrosis or screw loosening is frequently seen in lumbosacral stabilizations ending in S1, S2 screws are used more frequently to support S1 screws. This study aims to describe a new screw placement technique and location from S2. Revision surgery was applied to the patient who had previously undergone surgery with the rigid instrumentation system and encountered pseudoarthrosis during the follow-up period. Instrumentation was performed from S2 to the promontorium. The patient’s chronic low back pain arising due to pseudoarthrosis was reduced and a strong lumbosacral dynamic instrumentation was performed to the patient. Dual screw placement from S2 and/or screw placement in the S2-promontorium direction is a new alternative to provide a powerful instrumentation.

Thoracolumbar Fascia Enthesopathy as a Cause of Low Back Pain: A Retrospective and Follow-up Study

2021 ◽  
Author(s):  
Ouidade A. Tabesh ◽  
Roba Ghossan ◽  
Soha H Zebouni ◽  
Rafic Faddoul ◽  
Michel Revel ◽  
...  
Keyword(s):  
Low Back Pain ◽  
Back Pain ◽  
Iliac Crest ◽  
Pain Syndrome ◽  
Clinical Findings ◽  
Complete Relief ◽  
Low Back ◽  
Thoracolumbar Fascia ◽  
The Mean

Abstract Aim. To evaluate ultrasonography findings of Thoracolumbar Fascia (TLF) enthesis in patients with low back pain (LBP) due to iliac crest pain syndrome (ICPS). Method. The ultrasonographic and clinical findings of 60 patients with LBP due to ICPS were compared to those of 30 healthy volunteers with no LBP. Thickness of the TLF was measured with ultrasound (US) at its insertion on the iliac crest. Results. Forty-eight women and 12 men with a mean age of 42.1±11.3 years were diagnosed with ICPS. In patients, the mean thickness of the TLF was 2.51±0.70mm in affected sides compared to 1.81±0.44mm in the contralateral unaffected sides. The mean thickness difference of 0.82mm between the affected and non-affected sides was statistically significant (95%CI, 0.64-0.99, P<0.0001). In volunteers, the mean thickness of the TLF was 1.6±0.2mm. The mean thickness difference of 0.89mm between the affected sides of patients and volunteers was statistically significant (95%CI, 0.73-1.06, P<0.0001). Forty-two patients who didn’t improve with conservative therapy, received injections of methylprednisolone acetate and 1% lidocaine around the TLF enthesis. All patients reported complete relief of their LBP within 20 minutes of the injections thanks to the lidocaine anesthetic effect. Fifty-six (93.3%) patients were reached by phone for a long-term follow-up. Among them, 33 (58.9%) patients experienced a sustained complete pain relief after a mean follow-up of 45±19.3 months (range, 3-74 months). Conclusion. our findings suggest that TLF enthesopathy is a potential cause of nonspecific LBP that can be diagnosed using US.

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