Looking back at health data collected over 9 years to assess the long term effects of using opioids to treat chronic back pain

2020 ◽  
Author(s):  
Claus Manniche
Keyword(s):  
Back Pain ◽  
Chronic Back Pain ◽  
Health Data ◽  
Long Term Effects ◽  
Looking Back

Impairment Tutorial: Rating After IDET Procedures: Rating Permanent Impairment in Patients Who Have Already Had Intra-discal Electrothermal Annuloplasty (IDET) Procedures

2002 ◽  
Vol 7 (4) ◽  
pp. 6-7
Author(s):  
James B. Talmage ◽  
Robert H. Haralson
Keyword(s):  
Back Pain ◽  
Chronic Back Pain ◽  
Nonoperative Treatment ◽  
Low Back ◽  
Long Term Effects ◽  
Fourth Edition ◽  
Randomized Controlled ◽  
Proper Role

Abstract Intra-discal electrothermal annuloplasty (IDET) is a relatively recently described surgical procedure for chronic low back pain that is caused by degenerative discs is unresponsive to nonoperative treatment. IDET involves percutaneously inserting a catheter into a disc(s) and then heating the catheter to 90 °C for 17 minutes. Randomized controlled trials are in progress but not yet reported, so the proper role of IDET in the care of chronic back pain is not yet known. Neither the Fourth nor the Fifth Edition of the AMA Guides to the Evaluation of Permanent Impairment (AMA Guides) specifically addresses IDET. Evaluators who use the AMA Guides, Fifth Edition, apply the Diagnosis-related estimates (DRE) method to assess impairment when the patient is at maximum medical improvement (MMI). Because the long-term effects of IDET are not known and the patient's disc probably has been permanently changed by the procedure, evaluators should consult the AMA Guides, Fifth Edition, regarding categorization. This is because the injury and surgery have not resulted in a normal disc but rather one that may be prone to future problem episodes. If the evaluator chooses to use the range-of-motion method from the AMA Guides, Fourth Edition, in some scenarios the authors recommend considering IDET as if it were “surgical treatment” of the disc.

scholarly journals Long-term Complications of Unintentional Dural Puncture During Labor Epidural Analgesia: A Case-Control Study.

2021 ◽  
Author(s):  
Alexandre Lacombe ◽  
Kristi Downey ◽  
Xiang Y. Ye ◽  
Jose C.A. Carvalho
Keyword(s):  
Back Pain ◽  
Epidural Analgesia ◽  
Epidural Catheter ◽  
Chronic Headache ◽  
Dural Puncture ◽  
Chronic Back Pain ◽  
Case Control ◽  
Auditory Impairment ◽  
Control Study

Introduction: Epidural analgesia is the preferred method to manage pain during labor and delivery. The insertion of the epidural catheter can be complicated by unintentional dural puncture that may result in postdural puncture headache. There is limited evidence on the long term implications of this complication. We sought to investigate if women who sustained a dural puncture have a higher risk of developing chronic headache, low back pain and visual or auditory impairment. Methods: We conducted a 1:1 case-control study with women who delivered at our institution from January 2015 to December 2019. Cases were women who received epidural analgesia and sustained an unintentional dural puncture and controls were women who received epidural analgesia but did not sustain such complication. We matched cases and controls for date of delivery, age, and BMI. All women completed an online survey with validated questionnaires for diagnosis of chronic headache and chronic back pain. We used dichotomic (yes/no) questions to look for the presence of chronic visual and auditory impairment. Results: Sixty-three case-control pairs were studied. Women who sustained a dural puncture during their epidural catheter insertion had a higher risk of developing chronic headache [14.3%, versus 4.8%, p=0.049, AOR: 3.36 (1.05, 12.82)] and chronic back pain [39.7% versus 19.1%, p=0.009, AOR: 2.67 (1.25, 5.72)] than women who did not sustain a dural puncture. The incidence of chronic auditory impairment was also higher in the dural puncture group [14.3% versus 1.6%, p=0.007, AOR: 9.98 (1.21, 82.62)]. Conclusions: An unintentional dural puncture during epidural catheter insertion in parturients is associated with increased risk of chronic headache, back pain and auditory impairment.

scholarly journals Necrotizing fasciitis caused by the treatment of chronic non-specific back pain

2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Lilit Floether ◽  
Michael Bucher ◽  
Ralf Benndorf ◽  
Anna-Maria Burgdorff
Keyword(s):  
Back Pain ◽  
Chronic Back Pain ◽  
Intrathecal Injection ◽  
Local Anaesthetics ◽  
Term Therapy ◽  
Negative Effects ◽  
Case Presentation ◽  
Long Term Therapy

Abstract Background Chronic back pain is a multifactorial disease that occurs particularly in adults and has many negative effects on the quality of daily life. Therapeutic strategies are often multimodal and designed for a long-term therapy period. In some cases, one option is joint infiltration or intrathecal injection with local anaesthetics. An adverse effect of this intervention may be necrotic fasciitis, a disease with high mortality and few therapeutic options. Case presentation This case shows a 53-year-old female patient who developed necrotic fasciitis after infiltrations of the sacroiliac joint and after epidural-sacral and intrathecal injections. Conclusion Thanks to early and aggressive surgical intervention, antibiotic treatment and hyperbaric oxygenation, she survived this serious complication and was able to return to life.

scholarly journals Mimicking the Annulus Fibrosus Using Electrospun Polyester Blended Scaffolds

Nanomaterials ◽  
2019 ◽  
Vol 9 (4) ◽  
pp. 537 ◽  
Author(s):  
Alyah Shamsah ◽  
Sarah Cartmell ◽  
Stephen Richardson ◽  
Lucy Bosworth
Keyword(s):  
Back Pain ◽  
Annulus Fibrosus ◽  
Chronic Back Pain ◽  
Electrospun Fiber ◽  
Polymer Composition ◽  
Cell Phenotype ◽  
Intervertebral Disc Herniation ◽  
Chronic Lower Back Pain ◽  
Long Term Treatment

Treatments to alleviate chronic lower back pain, caused by intervertebral disc herniation as a consequence of degenerate annulus fibrosus (AF) tissue, fail to provide long-term relief and do not restore tissue structure or function. This study aims to mimic the architecture and mechanical environment of AF tissue using electrospun fiber scaffolds made from synthetic biopolymers-poly(ε-caprolactone) (PCL) and poly(L-lactic) acid (PLLA). Pure polymer and their blends (PCL%:PLLA%; 80:20, 50:50, and 20:80) are studied and material properties-fiber diameter, alignment, % crystallinity, tensile strength, and water contact angle-characterized. Tensile properties of fibers angled at 0°, 30°, and 60° (single layer scaffolds), and ±0°, ±30°, and ±60° (bilayer scaffolds) yield significant differences, with PCL being significantly stiffer with the addition of PLLA, and bilayer scaffolds considerably stronger. Findings suggest PCL:PLLA 50:50 fibers are similar to human AF properties. Furthermore, in vitro culture of AF cells on 50:50 fibers demonstrates attachment and proliferation over seven days. The optimal polymer composition for production of scaffolds that closely mimic AF tissue both structurally, mechanically, and which also support and guide favorable cell phenotype is identified. This study takes a step closer towards successful AF tissue engineering and a long-term treatment for sufferers of chronic back pain.

scholarly journals Long-term effects of an outpatient rehabilitation program in patients with chronic recurrent low back pain

2014 ◽  
Vol 23 (4) ◽  
pp. 779-785 ◽  
Author(s):  
Karin Pieber ◽  
Malvina Herceg ◽  
Michael Quittan ◽  
Robert Csapo ◽  
Rudolf Müller ◽  
...  
Keyword(s):  
Low Back Pain ◽  
Back Pain ◽  
Rehabilitation Program ◽  
Outpatient Rehabilitation ◽  
Low Back ◽  
Long Term Effects ◽  
Recurrent Low Back Pain

Long-Term Follow-up of Patients With Chronic Back Pain Treated in a Multidisciplinary Rehabilitation Program

Spine ◽  
1995 ◽  
Vol 20 (7) ◽  
pp. 801-806 ◽  
Author(s):  
Tom C. Lanes ◽  
Eugene F. Gauron ◽  
Kevin F. Spratt ◽  
Theodore J. Wernimont ◽  
Ernest M. Found ◽  
...  
Keyword(s):  
Back Pain ◽  
Chronic Back Pain ◽  
Rehabilitation Program ◽  
Multidisciplinary Rehabilitation ◽  
Long Term Follow Up

scholarly journals Evidence of Specific Cognitive Deficits in Patients with Chronic Low Back Pain under Long-Term Substitution Treatment of Opioids

2014 ◽  
Vol 17;1 (1;17) ◽  
pp. 9-19
Author(s):  
Haili Wang
Keyword(s):  
Information Processing ◽  
Back Pain ◽  
Cognitive Functions ◽  
Chronic Back Pain ◽  
Opioid Therapy ◽  
Healthy Controls ◽  
Cross Sectional ◽  
Time Pattern ◽  
Number Of Patients

Background: There is a growing number of patients worldwide being treated with longterm opioids for chronic non-cancer pain, although there is limited evidence for their effectiveness in improving pain and function. Opioid-use related adverse effects, especially in cognitive functioning in these patients, are rarely evaluated. Objectives: The present study investigated the cognitive functions of patients with chronic back pain who underwent long-term opioid treatment in comparison with those patients without opioid usage and healthy controls. Study Design: A prospective, nonrandomized, cross-sectional study. Setting: Multidisciplinary pain management clinic, specialty referral center, University Hospital in Germany. Methods: In a prospective cross-sectional design, 37 patients with chronic back pain who underwent long-term opioid therapy (OP) were compared with 33 patients with chronic back pain without opioid therapy (NO) and 25 healthy controls (HC). Assessment of primary outcome included cognitive function such as information processing speed, choice reaction time, pattern recognition memory, and executive function. Other data included pain, back function, depression and anxiety, use of medication, and education status. The relationship between cognitive functions and anxiety/depression was analysed. Results: Both patient groups needed significantly longer time in information processing when compared to HC (Group 1: 41.87 ± 20.47 Group 2: 38.29 ± 19.99 Group 3: 30.25 ± 14.19). Additionally, OP patients had significantly reduced spatial memory capacity, flexibility for concept change, and impaired performance in working memory assessment compared to NO patients and HC. The impaired cognitive outcomes were significantly associated with pain intensity, depression scores, and medication use. Limitations: Limitations include small number of patients with heterogeneous opioid therapy and the nonrandomized observational nature of the study. Conclusions: Our findings give a differential view into the cognitive changes from chronic back pain with and without long-term opioids treatment. Chronic back pain itself impairs some distinct cognitive functions. Long-term opioid therapy adds further cognitive impairment. Key words: Long-term opioid therapy, chronic back pain, cognitive dysfunction

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