scholarly journals Multicenter study evaluating factors associated with treatment outcome for low back pain injections

2021 ◽  
pp. rapm-2021-103247
Author(s):  
Steven P Cohen ◽  
Tina L Doshi ◽  
Connie Kurihara ◽  
David Reece ◽  
Edward Dolomisiewicz ◽  
...  
Keyword(s):  
Low Back Pain ◽  
Back Pain ◽  
Rating Scale ◽  
Depressive Symptomatology ◽  
Numerical Rating Scale ◽  
Leg Pain ◽  
Low Back ◽  
Epidural Steroid Injections ◽  
Patient Reported ◽  
Epidural Steroid

BackgroundThere has been a worldwide surge in interventional procedures for low back pain (LBP), with studies yielding mixed results. These data support the need for identifying outcome predictors based on unique characteristics in a pragmatic setting.MethodsWe prospectively evaluated the association between over two dozen demographic, clinical and technical factors on treatment outcomes for three procedures: epidural steroid injections (ESIs) for sciatica, and sacroiliac joint (SIJ) injections and facet interventions for axial LBP. The primary outcome was change in patient-reported average pain intensity on a numerical rating scale (average NRS-PI) using linear regression. For SIJ injections and facet radiofrequency ablation, this was average LBP score at 1 and 3 months postprocedure, respectively. For ESI, it was average leg pain 1- month postinjection. Secondary outcomes included a binary indicator of treatment response (success).Results346 patients were enrolled at seven hospitals. All groups experienced a decrease in average NRS-PI (p<0.0001; mean 1.8±2.6). There were no differences in change in average NRS-PI among procedural groups (p=0.50). Lower baseline pain score (adjusted coefficient −0.32, 95% CI −0.48 to −0.16, p<0.0001), depressive symptomatology (adjusted coefficient 0.076, 95% CI 0.039 to 0.113, p<0.0001) and obesity (adjusted coefficient 0.62, 95% CI 0.038 to 1.21, p=0.037) were associated with smaller pain reductions. For procedural outcome, depression (adjusted OR 0.94, 95% CI 0.91, 0.97, p<0.0001) and poorer baseline function (adjusted OR 0.59, 95% CI 0.36, 0.96, p=0.034) were associated with failure. Smoking, sleep dysfunction and non-organic signs were associated with negative outcomes in univariate but not multivariate analyses.ConclusionsIdentifying treatment responders is a critical endeavor for the viability of procedures in LBP. Patients with greater disease burden, depression and obesity are more likely to fail interventions. Steps to address these should be considered before or concurrent with procedures as considerations dictate.Trial registration numberNCT02329951.

scholarly journals Role of fasciae in nonspecific low back pain

2019 ◽  
Vol 29 (3) ◽  
Author(s):  
Giulia Casato ◽  
Carla Stecco ◽  
Riccardo Busin
Keyword(s):  
Low Back Pain ◽  
Back Pain ◽  
Rating Scale ◽  
Numerical Rating Scale ◽  
The Body ◽  
Deep Fascia ◽  
Low Back ◽  
Thoracolumbar Fascia ◽  
Patient Reported ◽  
Numerical Rating

More and more evidences show how the thoracolumbar fascia is involved with nonspecific low back pain. Additionally, recent studies about anatomy have shown the presence of a continuity between the thoracolumbar fascia and the deep fascia of the limbs; but actually, a dysfunction of just the thoracolumbar fascia or of the tightly contiguous myofascial tissue is generally recognized as possible cause of nonspecific low back pain. Five patients among those affected by nonspecific low back pain were manipulated just on those fascial spots that were painful, when palpated, and located in other areas of the body than the low back one. Each patient reported a clinically significant reduction of the painful symptoms (a Pain Numerical Rating Scale score difference ≥ 2) straight after the manipulation. A dysfunction of the myofascial tissue that is not tightly contiguous with the symptomatic area is then suggested to be taken into consideration among the causes of nonspecific low back-pain.

scholarly journals Association of Serum Serotonin and Pain in Patients with Chronic Low Back Pain before and after Spinal Surgery

2018 ◽  
Vol 2018 ◽  
pp. 1-6 ◽  
Author(s):  
Afshin Farhanchi ◽  
Behrouz Karkhanei ◽  
Negar Amani ◽  
Mashhood Aghajanloo ◽  
Elham Khanlarzadeh ◽  
...  
Keyword(s):  
Low Back Pain ◽  
Back Pain ◽  
Chronic Low Back Pain ◽  
Rating Scale ◽  
Numerical Rating Scale ◽  
Low Back ◽  
Significant Difference ◽  
Before And After ◽  
Postoperative Serum ◽  
Serum Serotonin

Introduction. In this study we are aiming to evaluate the changes of serum serotonin and its association with pain in patients suffering from chronic low back pain before and after lumbar discectomy surgery. Patients and Methods. A prospective study was performed on the patients referring to the outpatient clinic in Besat hospital, Hamadan University of Medical Sciences, Hamadan, Iran, during 2016. A 2 mL fasting blood sample was collected from each patient at preoperative day 1 and postoperative day 14 and they were measured for level of serum serotonin. Besides, all patients were asked for severity of their low back pain in preoperative day 1 and postoperative day 14 and scored their pain from zero to ten using a Numerical Rating Scale. Results. Forty patients with the mean age of 47 ± 13 yrs/old (range 25–77) including 15 (37.5%) males were enrolled into the study. The overall mean score of preoperative pain was significantly decreased from 7.4 ± 2.18 (range 4–10) to the postoperative pain score 3.87 ± 2.92 (range 0–10) (P < .001). The overall levels of pre- and postoperative serum serotonin were 3.37 ± 1.27 (range 1.1–6.4) and 3.58 ± 1.32 (range .94–7.1) ng/mL, respectively, with no significant difference (P = .09). The levels of pre- and postoperative serum serotonin were significantly higher in males and patients older than 50 yrs/old compared to the females and patients younger than 50 yrs/old, respectively (P = .03 and .005, respectively). A significant inverse correlation between the postoperative levels of pain and serum serotonin was observed (r = -.36 and P = .02). Conclusion. A negative medium strength linear relationship may exist between the postoperative serum serotonin and low back pain.

scholarly journals Comparison of Transforaminal and Parasagittal Epidural Steroid Injections in Patients With Radicular Low Back Pain

2015 ◽  
Vol 5 (3) ◽  
Author(s):  
Masoud Hashemi ◽  
Mohamad Reza Aryani ◽  
Sirus Momenzadeh ◽  
Seyed Sajad Razavi ◽  
Gholamreza Mohseni ◽  
...  
Keyword(s):  
Low Back Pain ◽  
Back Pain ◽  
Low Back ◽  
Steroid Injections ◽  
Epidural Steroid Injections ◽  
Epidural Steroid

scholarly journals Comparison of post-spinal back pain after midline versus paramedian approaches for urologic surgeries

2020 ◽  
Vol 12 (1) ◽  
Author(s):  
Payman Dadkhah ◽  
Masoud Hashemi ◽  
Babak Gharaei ◽  
Mohammad Hassan Bigdeli ◽  
Ali Solhpour
Keyword(s):  
Low Back Pain ◽  
Back Pain ◽  
Spinal Anesthesia ◽  
Rating Scale ◽  
Numerical Rating Scale ◽  
Spinous Process ◽  
Lithotomy Position ◽  
Significant Variable ◽  
Low Back ◽  
Increased Risk

Abstract Introduction Low back pain after spinal anesthesia is of concern in lithotomy position. During our study, low back pain in both midline and paramedian approaches after spinal anesthesia in lithotomy position was compared. Material and methods Spinal anesthesia was performed by two approaches of midline and paramedian by an expert. The midline at middle line and paramedian at 1 cm inferior and 1 cm lateral to the spinous process performed with the needle type of Quincke 25G. The severity of back pain in patients was measured with numerical rating scale method by an anesthesiology assistant 24 and 72 h and a week after surgery. Results A total of 139 patients were studied. After 24 h, back pain in the midline group was 21% and in the paramedian group was 25.4%, respectively. There were no significant differences between them. In the first 24 h, the only significant variable was the number of tries. In patients with ≥ 2 times of tries for performing spinal anesthesia, multivariate analysis of patients showed back pain to be 4.7 times more common compared to single try (OR 4.70, CI 1.79–10.18; p = 0.001). Conclusion There were no significant differences between the two methods of midline and paramedian approaches after spinal anesthesia in the incidence of back pain. However, two or more times of tries compared with one time try had increased risk of low back pain.

scholarly journals Association between intermittent low-back pain and superior cluneal nerve entrapment neuropathy

2016 ◽  
Vol 24 (2) ◽  
pp. 263-267 ◽  
Author(s):  
Yasuhiro Chiba ◽  
Toyohiko Isu ◽  
Kyongsong Kim ◽  
Naotaka Iwamoto ◽  
Daijiro Morimoto ◽  
...  
Keyword(s):  
Low Back Pain ◽  
Back Pain ◽  
Rating Scale ◽  
Numerical Rating Scale ◽  
Symptom Relief ◽  
Japanese Orthopaedic Association ◽  
Entrapment Neuropathy ◽  
Low Back ◽  
Lumbar Extension

OBJECT Superior cluneal nerve (SCN) entrapment neuropathy (SCNEN) is a cause of low-back pain (LBP) that can be misdiagnosed as a lumbar spine disorder. The clinical features and etiology of LBP remain poorly understood. In this study, 5 patients with intermittent LBP due to SCNEN who had previously received conservative treatment underwent surgery. The findings are reported and the etiology of LBP is discussed to determine whether it is attributable to SCNEN. METHODS Intermittent LBP is defined as a clinical condition in which pain is induced by standing or walking but is absent at rest. Between April 2012 and March 2013, 5 patients in this study who had intermittent LBP due to SCNEN underwent surgery. The patients included 3 men and 2 women, with a mean age of 66 years. The affected side was unilateral in 2 patients and bilateral in 3 (total sites, 8). The interval from symptom onset to treatment averaged 51.4 months; the mean postoperative follow-up period was 17.6 months. The clinical outcomes were assessed using the numerical rating scale (NRS) for LBP, the Japanese Orthopaedic Association (JOA) scale, and the Roland-Morris Disability Questionnaire (RDQ) preoperatively and at the last follow-up; these data were analyzed statistically. RESULTS None of the 5 patients reported LBP at rest. Intermittent LBP involving the iliac crest and buttocks was induced by standing or walking an average of 136 m. In 2 patients with unilateral involvement, LBP was improved only by SCN block. Surgeries were performed on 6 sites in 5 patients because the SCN block was only transiently effective. Patients’ SCNs penetrated the orifice of the thoracolumbar fascia. SCN kinking at the orifice was exacerbated at the lumbar-extension provocation posture, and radiating pain increased upon manual intraoperative compression of the SCN in this posture. After releasing the SCN surgically, disappearance of the pain was intraoperatively confirmed by manual compression of the SCN with the patients in the lumbar-extension posture. Surgery was effective in all 5 patients, and all clinical outcome scores indicated significant improvement (p < 0.05). CONCLUSIONS To the authors’ knowledge, this is the first report of patients with intermittent LBP due to SCNEN. Clinical and surgical evidence presented suggests that their LBP was exacerbated by lumbar extension and that symptom relief was obtained by SCN block or surgical release of the SCN entrapment. These results suggest that SCNEN should be considered as a causal factor in patients for whom walking elicits LBP.

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