Pain Reconceptualisation after Pain Neurophysiology Education in Adults with Chronic Low Back Pain: A Qualitative Study

Pain neurophysiology education (PNE) is an educational intervention for patients with chronic pain. PNE purports to assist patients to reconceptualise their pain away from the biomedical model towards a more biopsychosocial understanding by explaining pain biology. This study aimed to explore the extent, and nature, of patients’ reconceptualisation of their chronic low back pain (CLBP) following PNE. Eleven adults with CLBP underwent semistructured interviews before and three weeks after receiving PNE. Interviews were transcribed verbatim and thematically analysed in a framework approach using four a priori themes identified from our previous research: (1) degrees of reconceptualisation, (2) personal relevance, (3) importance of prior beliefs, and (4) perceived benefit of PNE. We observed varying degrees of reconceptualisation from zero to almost complete, with most participants showing partial reconceptualisation. Personal relevance of the information to participants and their prior beliefs were associated with the degree of benefit they perceived from PNE. Where benefits were found, they manifested as improved understanding, coping, and function. Findings map closely to our previous studies in more disparate chronic pain groups. The phenomenon of reconceptualisation is applicable to CLBP and the sufficiency of the themes from our previous studies increases confidence in the certainty of the findings.

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An Observational Study Comparing Fibromyalgia and Chronic Low Back Pain in Somatosensory Sensitivity, Motor Function and Balance

Healthcare ◽

10.3390/healthcare9111533 ◽

2021 ◽

Vol 9 (11) ◽

pp. 1533

Author(s):

José Antonio Mingorance ◽

Pedro Montoya ◽

José García Vivas Miranda ◽

Inmaculada Riquelme

Keyword(s):

Chronic Pain ◽

Low Back Pain ◽

Back Pain ◽

Observational Study ◽

Motor Function ◽

Chronic Low Back Pain ◽

Functional Performance ◽

Low Back ◽

Somatosensory Sensitivity ◽

Chronic Pain Conditions

Fibromyalgia (FM) and chronic low back pain (CLBP) have shared pathophysiology and have a considerable impact on patients’ daily activities and quality of life. The main objective of this study was to compare pain impact, somatosensory sensitivity, motor functionality, and balance among 60 patients with FM, 60 patients with CLBP, and 60 pain-free controls aged between 30 and 65 years. It is essential to know the possible differences existing in symptomatology of two of the major chronic pain processes that most affect the population, such as FM and CLBP. The fact of establishing possible differences in sensory thresholds, motor function, and proprioceptive measures among patients with FM and CLBP could bring us closer to a greater knowledge of the chronic pain process. Through an observational study, a comparison was made between the three groups (FM, CLBP, and pain-free controls) evaluating functional performance, postural balance, kinematic gait parameters, strength, depression, fatigue, and sensitivity to pain and vibration. Patients with chronic pain showed worse somatosensory sensitivity (p < 0.001) and motor function (p < 0.001) than pain-free controls. Moreover, patients with FM showed greater pain impact (p < 0.001) and bigger somatosensory (p < 0.001) and motor deficiencies (p < 0.001) than patients with CLBP. Further research should explore the possible reasons for the greater deterioration in patients with FM in comparison with other chronic pain conditions. Our results, showing the multiple areas susceptible of deterioration, make it necessary to adopt interdisciplinary interventions focused both on physical and emotional dysfunction.

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

Pain medicine ◽

10.31636/pmjua.v5i4.2 ◽

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.

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Effects of Manual Therapy on Pain and Function of Patients with Chronic Low Back Pain

The Journal of Korean Physical Therapy ◽

10.18857/jkpt.2017.29.2.85 ◽

2017 ◽

Vol 29 (2) ◽

pp. 85-90 ◽

Cited By ~ 1

Author(s):

Kyoung Kim ◽

Kwan-sub Lee ◽

Seok-Joo Choi ◽

Chun-Bae Jeon ◽

Gook-Joo Kim

Keyword(s):

Low Back Pain ◽

Back Pain ◽

Manual Therapy ◽

Chronic Low Back Pain ◽

Low Back ◽

And Function

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Efficacy and safety of fasinumab in patients with chronic low back pain: a phase II/III randomised clinical trial

Annals of the Rheumatic Diseases ◽

10.1136/annrheumdis-2020-217259 ◽

2020 ◽

pp. annrheumdis-2020-217259

Author(s):

Paula Dakin ◽

Alan J Kivitz ◽

Joseph S Gimbel ◽

Nebojsa Skrepnik ◽

Stephen J DiMartino ◽

...

Keyword(s):

Low Back Pain ◽

Back Pain ◽

Phase Ii ◽

Chronic Low Back Pain ◽

Randomised Clinical Trial ◽

Controlled Study ◽

Low Back ◽

Efficacy And Safety ◽

Double Blind ◽

And Function

ObjectivesTo study the efficacy and safety of fasinumab in moderate-to-severe, chronic low back pain (CLBP).MethodsIn this phase II/III, double-blind, placebo-controlled study, patients with CLBP aged ≥35 years with inadequate pain relief/intolerance to acetaminophen, non-steroidal anti-inflammatory drugs and opioids were randomised to fasinumab 6 or 9 mg subcutaneous every 4 weeks (Q4W), 9 mg intravenous every 8 weeks (Q8W) or placebo. Primary endpoint was change from baseline to week 16 in average daily low back pain intensity (LBPI) numeric rating score. Key secondary efficacy variables included Roland-Morris Disability Questionnaire (RMDQ) and Patient Global Assessment (PGA). The results are based on a modified intent-to-treat analysis of 563/800 planned patients when enrolment was stopped early given emerging signals of joint risk in other osteoarthritis (OA) studies at doses being tested here.ResultsSignificant placebo-adjusted LBPI reductions at week 16 were observed for fasinumab 9 mg Q4W and Q8W (least squares mean (standard error) −0.7 (0.3); both nominal p<0.05), but not 6 mg (–0.3 (0.3); p=0.39). RMDQ and PGA improvements to week 16 were greatest for fasinumab 9 mg intravenous. Numerically greater efficacy occurred in patients with, versus those without, peripheral OA (pOA) over 16 weeks. Treatment-emergent adverse events (AEs) occurred in 274/418 (65.6%) patients in the combined fasinumab groups and 94/140 (67.1%) placebo patients. Joint AEs, mostly rapid progressive OA type 1, were more frequent in the combined fasinumab groups (19 events in 16 patients (3.8%) vs 1 event in 1 patient (0.7%) for placebo); all except one occurred in pOA patients.ConclusionsFasinumab highest doses, but not lower dose, improved both CLBP pain and function. Most joint AEs occurred in pOA patients, consistent with earlier findings in symptomatic OA. Further study is needed of patients with CLBP with and without pOA to determine optimal benefit–risk.

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Effective Treatment of Chronic Low Back Pain in Humans Reverses Abnormal Brain Anatomy and Function

Journal of Neuroscience ◽

10.1523/jneurosci.5280-10.2011 ◽

2011 ◽

Vol 31 (20) ◽

pp. 7540-7550 ◽

Cited By ~ 329

Author(s):

D. A. Seminowicz ◽

T. H. Wideman ◽

L. Naso ◽

Z. Hatami-Khoroushahi ◽

S. Fallatah ◽

...

Keyword(s):

Low Back Pain ◽

Back Pain ◽

Effective Treatment ◽

Chronic Low Back Pain ◽

Brain Anatomy ◽

Low Back ◽

And Function ◽

Abnormal Brain

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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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Influence of sleep problems and co-occurring musculoskeletal pain on long-term prognosis of chronic low back pain: the HUNT Study

Journal of Epidemiology & Community Health ◽

10.1136/jech-2019-212734 ◽

2019 ◽

Vol 74 (3) ◽

pp. 283-289 ◽

Cited By ~ 1

Author(s):

Eivind Schjelderup Skarpsno ◽

Paul Jarle Mork ◽

Tom Ivar Lund Nilsen ◽

Anne Lovise Nordstoga

Keyword(s):

Chronic Pain ◽

Low Back Pain ◽

Back Pain ◽

Musculoskeletal Pain ◽

Chronic Low Back Pain ◽

Sleep Problems ◽

Low Back ◽

Hunt Study ◽

Long Term Prognosis

BackgroundWe investigated the influence of sleeplessness and number of insomnia symptoms on the probability of recovery from chronic low back pain (LBP), and the possible interplay between sleeplessness and co-occurring musculoskeletal pain on this association.MethodsThe study comprised data on 3712 women and 2488 men in the Norwegian HUNT study who reported chronic LBP at baseline in 1995–1997. A modified Poisson regression model was used to calculate adjusted risk ratios (RRs) for the probability of recovery from chronic LBP at follow-up in 2006–2008, associated with sleep problems and co-occurring musculoskeletal pain at baseline.ResultsCompared with persons without sleeplessness, persons who often/always experienced sleeplessness had a lower probability of recovery from chronic LBP (RR 0.65, 95% CI 0.57 to 0.74 in women and RR 0.81, 95% CI 0.69 to 0.95 in men). Although there was no clear evidence of statistical interaction between sleeplessness and co-occurring musculoskeletal pain, women and men who often/always experienced sleeplessness and had ≥5 additional chronic pain sites had RRs of recovery of 0.40 (95% CI 0.33 to 0.48) and 0.59 (95% CI 0.45 to 0.78), respectively, compared with persons without sleeplessness and 1–2 chronic pain sites.ConclusionThese findings suggest that preventing or reducing sleep problems among people with chronic LBP may have the potential of improving the long-term prognosis of this condition, also among those with several additional pain sites.

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The effectiveness of walking versus exercise on pain and function in chronic low back pain: a systematic review and meta-analysis of randomized trials

Disability and Rehabilitation ◽

10.1080/09638288.2017.1410730 ◽

2017 ◽

Vol 41 (6) ◽

pp. 622-632 ◽

Cited By ~ 11

Author(s):

Carla Vanti ◽

Simone Andreatta ◽

Silvia Borghi ◽

Andrew Anthony Guccione ◽

Paolo Pillastrini ◽

...

Keyword(s):

Systematic Review ◽

Low Back Pain ◽

Back Pain ◽

Chronic Low Back Pain ◽

Randomized Trials ◽

Meta Analysis ◽

Low Back ◽

And Function

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Chronic pain and depression. III. Family history study of depression and alcoholism in chronic low back pain patients

Pain ◽

10.1016/0304-3959(86)90040-0 ◽

1986 ◽

Vol 24 (2) ◽

pp. 185-190 ◽

Cited By ~ 26

Author(s):

Randal D. France ◽

Ranga K. Rama Krishnan ◽

Mary Trainor

Keyword(s):

Chronic Pain ◽

Low Back Pain ◽

Back Pain ◽

Family History ◽

Chronic Low Back Pain ◽

Low Back ◽

Pain Patients

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Family History and Severity of Disability Associated with Chronic Low Back Pain

Psychological Reports ◽

10.2466/pr0.1985.57.3.813 ◽

1985 ◽

Vol 57 (3) ◽

pp. 813-814 ◽

Cited By ~ 13

Author(s):

C. Alec Pollard

Keyword(s):

Chronic Pain ◽

Low Back Pain ◽

Back Pain ◽

Family History ◽

Chronic Low Back Pain ◽

Low Back ◽

Pain Disability Index ◽

Pain Disability ◽

Severity Of Disability ◽

Chronic Pain Conditions

76 patients with chronic low back pain were asked to complete the Pain Disability Index and a family history pain checklist. A significant positive relationship was found between severity of chronic pain disability and the number of chronic pain conditions in the patients' families of origin and genesis. These findings support the position that pain disability is learned from family members, but controlled research is needed before dismissing the possible role of genetic and other factors.

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