Pain chronification and the important role of non-disease-specific symptoms in patients with systemic sclerosis

Abstract Background Pain is a frequent, yet inadequately explored challenge in patients with systemic sclerosis (SSc). This study aimed to conduct an extensive pain assessment, examining pain chronification and its association with disease manifestations. Methods Consecutive SSc patients attending their annual assessment were included. SSc-specific features were addressed as defined by the European Scleroderma Trials and Research (EUSTAR) guidelines. Pain analysis included intensity, localization, treatment, chronification grade according to the Mainz Pain Staging System (MPSS), general well-being using the Marburg questionnaire on habitual health findings (MFHW) and symptoms of anxiety and depression using the Hospital Anxiety and Depression Scale (HADS). Results One hundred forty-seven SSc patients completed a pain questionnaire, and 118/147 patients reporting pain were included in the analysis. Median pain intensity was 4/10 on a numeric rating scale (NRS). The most frequent major pain localizations were hand and lower back. Low back pain as the main pain manifestation was significantly more frequent in patients with very early SSc (p = 0.01); those patients also showed worse HADS and MFHW scores. Regarding pain chronification, 34.8% were in stage I according to the MPSS, 45.2% in stage II and 20.0% in stage III. There was no significant correlation between chronification grade and disease severity, but advanced chronification was significantly more frequent in patients with low back pain (p = 0.024). It was also significantly associated with pathological HADS scores (p < 0.0001) and linked with decreased well-being and higher use of analgesics. Conclusions Our study implies that also non-disease-specific symptoms such as low back pain need to be considered in SSc patients, especially in early disease. Since low back pain seems to be associated with higher grades of pain chronification and psychological problems, our study underlines the importance of preventing pain chronification in order to enhance the quality of life.

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

Medicina ◽

10.3390/medicina57040327 ◽

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.

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Long-term improvements following a residential combined physical and psychological programme for chronic low back pain

BMJ Open Quality ◽

10.1136/bmjoq-2020-001068 ◽

2021 ◽

Vol 10 (2) ◽

pp. e001068

Author(s):

Shaun Wellburn ◽

Cormac G Ryan ◽

Andrew Coxon ◽

Alastair J Dickson ◽

D John Dickson ◽

...

Keyword(s):

Low Back Pain ◽

Back Pain ◽

Outcome Measures ◽

Chronic Low Back Pain ◽

Rating Scale ◽

Secondary Outcome ◽

Low Back ◽

Residential Setting ◽

Wide Range

ObjectivesEvaluate the outcomes and explore experiences of patients undergoing a residential combined physical and psychological programme (CPPP) for chronic low back pain.DesignA longitudinal observational cohort design, with a parallel qualitative design using semistructured interviews.SettingResidential, multimodal rehabilitation.Participants136 adults (62 male/74 female) referred to the CPPP, 100 (44 male/56 female) of whom completed the programme, during the term of the study. Ten (2 male/8 female) participated in the qualitative evaluation.InterventionA 3-week residential CPPP.Outcome measuresPrimary outcome measures were the STarT Back screening tool score; pain intensity—11-point Numerical Rating Scale; function—Oswestry Disability Index (ODI); health status/quality of life—EQ-5D-5L EuroQol five-Dimension-five level; anxiety—Generalised Anxiety Disorder-7; depression—Patient Health Questionnaire-9. Secondary outcome measures were the Global Subjective Outcome Scale; National Health Service Friends and Family Test;.ResultsAt discharge, 6 and 12 months follow ups, there were improvements from baseline that were greater than minimum clinically important differences in each of the outcomes (with the sole exception of ODI at discharge). At 12 months, the majority of people considered themselves a lot better (57%) and were extremely likely (86%) to recommend the programme to a friend. The qualitative data showed praise for the residential nature of the intervention and the opportunities for interaction with peers and peer support. There were testimonies of improvements in understanding of pain and how to manage it better. Some participants said they had reduced, or stopped, medication they had been taking to manage their pain.ConclusionsParticipants improved, and maintained long term, beyond minimum clinically important differences on a wide range of outcomes. Participants reported an enhanced ability to self-manage their back pain and support for the residential setting.

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

Pain Research and Treatment ◽

10.1155/2018/4901242 ◽

2018 ◽

Vol 2018 ◽

pp. 1-6 ◽

Cited By ~ 1

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.

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Translation, Cross-Cultural Adaptation, and Validation of the Portuguese Version of the Rotterdam Elderly Pain Observation Scale

Dementia and Geriatric Cognitive Disorders Extra ◽

10.1159/000520455 ◽

2021 ◽

pp. 314-323

Author(s):

Julieta Seixas-Moizes ◽

Anneke Boerlage ◽

Érica Negrini Lia ◽

Lucas Emmanuel Lopes e Santos ◽

Miriane Lucindo Zucoloto ◽

...

Keyword(s):

Low Back Pain ◽

Back Pain ◽

Correlation Coefficient ◽

Health Professionals ◽

Cultural Adaptation ◽

Healthcare Professionals ◽

Rating Scale ◽

Low Back ◽

Portuguese Version ◽

Observation Scale

Introduction: This study reports on the translation, cultural adaptation, and validation of a Portuguese version of the Rotterdam Elderly Pain Observation Scale (REPOS), a Dutch scale to assess pain in patients who cannot communicate, with or without dementia. Methods: This is a multicenter study in pain and neurological units involving Brazil (clinical phase) and the Netherlands (training phase). We performed a retrospective cross-sectional, 2-staged analysis, translating and culturally adapting the REPOS to a Portuguese version (REPOS-P) and evaluating its psychometric properties. Eight health professionals were trained to observe patients with low back pain. REPOS consists of 10 behavioral items scored as present or absent after a 2-min observation. The REPOS score of ≥3 in combination with the Numerical Rating Scale (NRS) of ≥4 indicated pain. The Content Validity Index (CVI) in all items and instructions showed CVI values at their maximum. According to the higher correlation coefficient found between NRS and REPOS-P, it may be suggested that there was an adequate convergent validity. Results: The REPOS-P was administered to 80 patients with a mean age of 60 years (SD 11.5). Cronbach’s alpha coefficient showed a moderate internal consistency of REPOS-P (α = 0.62), which is compatible with the original study of REPOS. All health professionals reached high levels of interrater agreement within a median of 10 weeks of training, assuring reproducibility. Cohen’s kappa was 0.96 (SD 0.03), and the intraclass correlation coefficient was 0.98 (SD 0.02), showing high reliability of REPOS-P scores between the trainer (researcher) and the trainees (healthcare professionals). The Pearson correlation coefficient was 0.95 (95% confidence interval 0.94–0.97), showing a significant correlation between the total scores of REPOS-P and NRS. Conclusion: The REPOS-P was a valuable scale for assessing elderly patients with low back pain by different healthcare professionals. Short application time, ease of use, clear instructions, and the brief training required for application were essential characteristics of REPOS-P.

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A Qualitative Study on Coping Strategies Among Patients with Non-Specific Low-Back Pain

Middle East Journal of Rehabilitation and Health ◽

10.5812/mejrh.103387 ◽

2020 ◽

Vol 7 (3) ◽

Author(s):

Adesola Ojo Ojoawo ◽

Taiwo Oluwaseun Arasanmi ◽

Chidozie Emmanuel Mbada

Keyword(s):

Low Back Pain ◽

Back Pain ◽

Activities Of Daily Living ◽

Coping Strategies ◽

Daily Living ◽

Rating Scale ◽

Low Back ◽

Religious Activities ◽

Work Related ◽

And Coping

Background: Non-specific low-back pain (NSLBP) is a common health problem worldwide, but the perception and coping strategies used by patients are underreported. Objectives: The objectives of the study were to evaluate the perception of patients with NSLBP, the ways the pain interrfered with their basic life, and coping strategies employed by them. Methods: Twenty patients consisting of 10 males (50%) and 10 females (50%) participated in this study. A qualitative interview was conducted using a three-section modified structured interview guide by Gwenda. Section A contained sociodemographic information, section B was the numerical pain rating scale, and section C asked questions about the pain duration, the ways of pain interference with the patient’s life, and strategies used to cope with pain. The data were analyzed using thematic content analysis. Results: The results showed that 50% of the patients were within the age range of 58 years or above. Ten (50%) patients perceived that NSLBP was caused by work-related activities and 10% perceived that NSLBP was a spiritual problem. Fifty percent reported that the pain interfered with their activities of daily living, and four (20%) mentioned that NSLBP interfered with their sexual function and religious activities. Concerning the coping strategy, 40% used prayer, 15% usually ignored the pain, and 35% used the conventional approach. Conclusions: It can be concluded that half of the patients with NSLBP perceived NSLBP to be caused by work-related activities. Besides, NSLBP interfered with basic activities of daily living, and about 40% were coping with NSLBP with prayer and spiritual means.

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Pharmacological and toxicological profile of opioid-treated, chronic low back pain patients entering a mindfulness intervention randomized controlled trial

Journal of Opioid Management ◽

10.5055/jom.2014.0222 ◽

2014 ◽

Vol 10 (5) ◽

pp. 323 ◽

Cited By ~ 8

Author(s):

Aleksandra Zgierska, MD, PhD ◽

Margaret L. Wallace, PharmD, BCACP ◽

Cindy A. Burzinski, MS ◽

Jennifer Cox, BS ◽

Miroslav Backonja, MD

Keyword(s):

Low Back Pain ◽

Back Pain ◽

Chronic Low Back Pain ◽

Drug Testing ◽

Illicit Drugs ◽

Rating Scale ◽

Controlled Trial ◽

Low Back ◽

Cross Sectional ◽

Toxicological Profile

Objective: Refractory chronic low back pain (CLBP) often leads to treatment with long-term opioids. Our goal was to describe the pharmaco-toxicological profile of opioid-treated CLBP patients and identify potential areas for care optimization.Design: Cross-sectional analysis.Setting: Outpatient primary care.Participants: CLBP patients prescribed ≥ 30 mg/d of morphine-equivalent dose (MED) for ≥3 months.Outcome Measures: Self-reported clinical, medication (verified) and substance use, and urine drug testing (UDT) data were collected.Results: Participants (N = 35) were 51.8 ± 9.7 years old, 80 percent female with CLBP for 14.2 ± 10.1 years, treated with opioids for 7.9 ± 5.7 years, with severe disability (Oswestry Disability Index score: 66.7 ± 11.4), and average pain score of 5.6 ± 1.5 (0-10 rating scale). Participants reported using tobacco (N = 14), alcohol (N = 9) and illicit drugs or unprescribed medications (N = 10). On average, participants took 13.4 ± 6.8 daily medications, including 4.7 ± 1.8 pain-modulating and 4.7 ± 2.0 sedating medications. Among prescribed opioids, 57.1 percent were long-acting and 91.4 percent were short-acting, with a total of 144.5 ± 127.8 mg/d of MED. Sixteen participants were prescribed benzodiazepines and/or zolpidem/zaleplon. Fifteen participants had UDT positive for illicit drugs or unprescribed medications; in addition, eight tested positive for alcohol and 19 for cotinine. Compared to those with negative UDTs, those with positive UDTs (N = 15) received lower daily “total” and “extended release” opioid doses, and were more likely to test positive for cotinine (p < 0.05).Conclusions: Study findings corroborate existing evidence for high medication burden and high likelihood of substance misuse among opioid-treated CLBP patients. Further research is needed to help understand causality and ways to optimize care and clinical outcomes.

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Occupational Related Upper and Low Back Pain Among Working Population of Ethiopia: Systematic Review and Meta-Analysis

10.21203/rs.3.rs-257589/v4 ◽

2021 ◽

Author(s):

Dechasa Adare Mengistu ◽

Yohannes Mulugeta Demmu ◽

Addisu Alemu

Keyword(s):

Systematic Review ◽

Low Back Pain ◽

Back Pain ◽

Meta Analysis ◽

Well Being ◽

Boolean Logic ◽

Cochrane Library ◽

Low Back ◽

Working Population ◽

Pooled Prevalence

Abstract Background: Back pains, such as low and upper back pains are among the most common musculoskeletal conditions that can cause major public health and socioeconomic problems. Back pain is one of the leading causes of disability that reduces worker performance and well-being and increases absence from work, which can cause an enormous economic burden. In developing countries, particularly in Ethiopia, there is no adequate evidence on the overall prevalence of occupational-related low and upper back pains and remain less prioritized and empirically unrepresented. Therefore, this study aimed to determine the prevalence of occupational-related low and upper back pains among the working population of Ethiopia.Methods: This systematic review and meta-analysis considered studies conducted in Ethiopia, written in English, and published from 2017-2020. Articles were searched from nine electronic databases (Web of Science, SCOPUS, PubMed, Google Scholar, CINAHL, Cochrane Library, African Index Medicus, African Journals Online database and Science Direct) using a combination of Boolean logic operators, Medical Subject Headings and main keywords. The quality assessment of the articles was performed using Joanna Briggs Institute Critical Appraisal tools to determine the relevance of the articles to the study. A random effects model was used to estimate the pooled prevalence, the 95% confidence interval, and the degree of heterogeneity among the included studies. Sensitivity analyzes were performed to identify the influence of outliers and to identify sources of heterogeneity.Results: Of the 1,114 studies identified from the included databases, 20 studies were included in the systematic review and meta-analysis. The pooled prevalence of occupational-related upper and low back pain in the previous year was 27.1% [95% CI: 18.4, 37.9] and 54.2% [95% CI: 48.2, 60.0], respectively. Based on a subgroup analysis by publication year, study population and countries where the studies are conducted, the prevalence of upper back pain was 43.8% [95% CI: 39.3, 47.7], 34.7% [95% CI: 33.1, 36.2], and 36.2% [95% CI: 33.6, 39.0], respectively, while the prevalence of low back pain was 61.8% [95% CI: 58.9, 64.6], 52.8% [95% CI: 51.3, 54.3] and 55.2% [95% CI: 51.4, 59.0], respectively.Conclusions: This systematic review and meta-analysis found that 54.2% of the included study participants experienced low back pain in the previous year, while 27.1% experienced upper back pain. These problems may be reduced by considering proper observation of the principles of ergonomics in the workplace, and performing physical exercises on a regular basis.

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Physical activity in patients with nonspecific low back painin therapy

Medical Council ◽

10.21518/2079-701x-2021-19-67-72 ◽

2021 ◽

pp. 67-72

Author(s):

V. A. Parfenov ◽

I. A. Lamkova

Keyword(s):

Physical Activity ◽

Low Back Pain ◽

Back Pain ◽

Rating Scale ◽

Therapy Group ◽

Individual Characteristics ◽

Lumbar Pain ◽

Low Back ◽

Standard Therapy Group ◽

The Individual

Introduction. Kinesitherapy (KT) – one of the leading areas of patient care with chronic nonspecific (musculoskeletal pain) low back pain. For chronic lumbar pain, a standard KT is commonly used, that includes group sessions with a medical specialist. Often not taking into account the individual characteristics of patients, their attitude to KT, does not use a backpain education program in combination with KT (extended KT). Physical activity and hypodynamia are compared in patients with chronic nonspecificlow back pain in standard KT and extended KT.Aim of study is to assess the effectiveness of the standard and extended KT in the enhancement of physical activity.Materials and methods. 71 patients were observed (17 men and 54 women, average age 55.09 ± 13 years) with chronic nonspecific low back pain. Patients received non-steroidal anti-inflammatory drugs (NSAIDs) as painkillers. 34 patients received a standard KT, 37 patients – an extended KT. Patients were asked to complete the Numeric Pain Rating Scale (NPRS), the Oswestry Low Back Pain Disability Questionnaire, and the International Physical Activity Questionnaire (IPAQ) at baseline, after 7 days and 90 days.Results and discussion. In the extended KT group, physical activity increased from 11 (7–16) points to 16 (13–19) points after 7 days (p = 0.001) and up to 23 (15–26) points after 3 months (p = 0.0002). There has been a statistically significant decrease in the proportion of patients with hypodynamy (p = 0.0015). There is no statistically significant increase in physical activity in the standard therapy group. The use of NSAIDs in non-specific low back pain is discussed, the effectiveness of the use of dexketoprofen (Dexalgin) during lumbar pain is noted.Conclusion. In the case of nonspecific low back pain, the extended KTimprovesphysical activity and reduce hypodynamy.

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Effectiveness of Maitland Grade I and II Spinal Mobilization for Chronic Low Back Pain

Annals of King Edward Medical University ◽

10.21649/akemu.v24i1.2307 ◽

2018 ◽

Vol 24 (1) ◽

pp. 577-580

Author(s):

Komal Mushtaq ◽

Shoaib Waqas ◽

Hafiz Muhammad Asim

Keyword(s):

Low Back Pain ◽

Back Pain ◽

Standard Deviation ◽

Chronic Low Back Pain ◽

Rating Scale ◽

P Value ◽

Team Approach ◽

Low Back ◽

Treatment Frequency ◽

Similar Treatment

Chronic low back pain (CLBP) can be managed by multidisciplinary team approach especially physiotherapy and rehabilitation. In this study, effectiveness of spinal manual therapy (maitland grade I and II mobilization) for CLBP management was assessed. Methods: All subjects in the study were provided maitland grade I and II spinal mobilization for 20 minutes each. A similar treatment frequency was applied and consisted on three sessions per week for 2 continuous weeks. Numeric pain rating scale (NPRS) was applied to assess the pain severity levels before treatment and after treatment. Data were normally distributed and therefore, change in pain intensity was measured by “t” test using SPSS version 23.0. Results: The calculated mean pain score on NPRS before treatment was 3.90 (standard deviation, 0.3038) and after treatment it was 1.65 (standard deviation, 0.8638). The calculated t-value was 12.08 (p value=0.000). Conclusion: These results clearly demonstrate that the maitland G1 and G2 spinal mobilization can be exploited as an effective treatment choice for chronic low back pain.

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Frequency of low back pain in young adults and its relationship with different mattresses

Journal of the Pakistan Medical Association ◽

10.47391/jpma.03-494 ◽

2021 ◽

Vol 71 (9) ◽

Author(s):

Mudassar Rooh Ul Muazzam ◽

Salma Abbas ◽

Sidra Abbas ◽

Muhammad Ashar Rafi

Keyword(s):

Young Adults ◽

Low Back Pain ◽

Back Pain ◽

Rating Scale ◽

Cross Sectional Study ◽

Study Data ◽

Twin Cities ◽

Low Back ◽

Cross Sectional ◽

Numeric Pain Rating Scale

AbstractObjective: The purpose of this study was to find out the frequency of low back pain in young adults and its relationship with the mattresses they use.Methodology: This cross sectional study was carried out in 6 months in twin cities (Rawalpindi and Islamabad). The sample size for this study was 366. For data collection, self-structured questionnaire was used along with Modified Oswestry Scale and Numeric Pain Rating Scale (NPRS). The inclusion criteria for this study was young adults with age limit 18-35 years and the participants who used the same kind of mattress for more than 3 months. Post-surgical patients and the patients diagnosed with lumbar pathology were excluded from this study. Data was then analyzed through SPSS statistics 24.Results: Mean age of the participants was 22.06±3.74 years. Majority 208(56.38%) participants were feeling low back pain and out of these 208 participants, Pain was most prevalent 30(68.18%) in firm mattress users followed by 128(59.25%) in foam mattress users. Low back pain was more associated with those participants who were not changing their mattresses for more than three years.Conclusion: Low back pain is frequently present in young adults and more prevalent in those participants who were using same firm or foam mattresses for more than three years.Keywords: Back pain, Mattresses, Posture, and Young Adults. Continuous...

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