scholarly journals Spinal pain: causes and treatment policy

2018 ◽  
Vol 12 (3) ◽  
pp. 53-60
Author(s):  
Yu. A. Olyunin
Keyword(s):  
Back Pain ◽  
Structural Changes ◽  
Pain Syndrome ◽  
Opioid Analgesics ◽  
Spinal Pain ◽  
Muscle Relaxants ◽  
Medical Problems ◽  
Relieve Pain ◽  
Inflammatory Drugs ◽  
Current Guidelines

Chronic pain in the spine is one of the most urgent medical problems. Clinical and instrumental studies fail to reveal that most patients with back pain have any structural changes that may contribute to its occurrence. It is considered that the pain may be caused by the strain of muscles and ligaments located in the lower back, by the overload of these segments, and by detraining. If the cause of the pain syndrome cannot be established, the pain in the spine is regarded as nonspecific. It is believed that behavioral, psychological, and social factors can play an important role in the development of pain. Therefore, current guidelines propose to apply a biopsychosocial approach in patients with back pain. At the same time, much attention is paid to patient self-treatment, exercise therapy, psychotherapy, and some other auxiliary methods. When nonpharmacological interventions are insufficiently effective, drug therapy is indicated. Nonsteroidal anti-inflammatory drugs (NSAIDs), paracetamol, opioid analgesics, and muscle relaxants are used to treat nonspecific spinal pain. Pharmacotherapy is usually initiated with the use of NSAIDs. They can effectively relieve pain sndrome, but the possibilities of their use in a large proportion of patients are significantly limited due to adverse reactions (ARs). Gastrointestinal and cardiovascular ARs most commonly occur. The likelihood of ARs can be substantially reduced by the use of aceclofenac (AirtalR) that is characterized by a favorable gastrointestinal and cardiovascular safety profile. Paracetamol, opioid analgesics, and muscle relaxants are also used in the combination treatment of these patients.

scholarly journals Comparative analysis of different methods of anesthesia in patients with acute pancreatitis using pain scales

2016 ◽  
Vol 97 (2) ◽  
pp. 217-221
Author(s):  
V N Shilenok ◽  
E V Nikitina
Keyword(s):  
Acute Pancreatitis ◽  
Comparative Analysis ◽  
Visual Analogue Scale ◽  
Pain Intensity ◽  
Epidural Anesthesia ◽  
Analogue Scale ◽  
Pain Syndrome ◽  
Opioid Analgesics ◽  
Inflammatory Drugs ◽  
Anti Inflammatory

Aim. To conduct a comparative analysis of used anesthesia methods in patients with acute pancreatitis in intensive care units settings using pain scales.Methods. Depending on the anesthesia type, 44 patients with acute pancreatitis were divided into three groups: the first group received intramuscular injections of nonsteroidal anti-inflammatory drugs and spasmolytics, the second group - intramuscular injections of non-steroidal anti-inflammatory drugs and opioid analgesics, the third group - epidural anesthesia with local anesthetics. Comparative analysis of pain character, intensity was conducted, its dynamics in patients of all groups amid anesthesia was evaluated using a visual analogue scale, verbal rating scale, verbal descriptor scale, McGill pain questionnaire.Results. Baseline pain intensity in patients of all groups was high. Patients estimated this pain as «very strong». The time and the level of pain intensity reduction for various anesthesia types had differences. Pain syndrome was eliminated slower in patients of the second group. By the end of the 1st day, patients of this group continued to complain of «strong» pain. Pain intensity decreased only on the 2nd day - patients reported «moderate» pain. Pain syndrome was not completely eliminated in these patients for 2 days of anesthesia. 97.7% of patients reported that the visual analogue scale is the most acceptable pain assessment scale for them.Conclusion. In patients with acute pancreatitis, the most optimal anesthesia types are intramuscular nonsteroidal anti-inflammatory drugs with spasmolytics and prolonged epidural anesthesia with local anesthetics; intramuscular administration of opioid analgesics with non-steroidal anti-inflammatory drugs is less effective in relieving pain.

scholarly journals Comprehensive Review of Epidemiology, Scope, and Impact of Spinal Pain

2009 ◽  
Vol 4;12 (4;7) ◽  
pp. E35-E70
Author(s):  
Laxmaiah Manchikanti
Keyword(s):  
Health Care ◽  
Chronic Pain ◽  
Low Back Pain ◽  
Back Pain ◽  
Neck Pain ◽  
Pain Syndrome ◽  
Spinal Pain ◽  
The United States ◽  
Low Back ◽  
Chronic Pain Syndrome

Persistent pain interfering with daily activities is common. Chronic pain has been defined in many ways. Chronic pain syndrome is a separate entity from chronic pain. Chronic pain is defined as, “pain that persists 6 months after an injury and beyond the usual course of an acute disease or a reasonable time for a comparable injury to heal, that is associated with chronic pathologic processes that cause continuous or intermittent pain for months or years, that may continue in the presence or absence of demonstrable pathologies; may not be amenable to routine pain control methods; and healing may never occur.” In contrast, chronic pain syndrome has been defined as a complex condition with physical, psychological, emotional, and social components. The prevalence of chronic pain in the adult population ranges from 2% to 40%, with a median point prevalence of 15%. Among chronic pain disorders, pain arising from various structures of the spine constitutes the majority of the problems. The lifetime prevalence of spinal pain has been reported as 54% to 80%. Studies of the prevalence of low back pain and neck pain and its impact in general have shown 23% of patients reporting Grade II to IV low back pain (high pain intensity with disability) versus 15% with neck pain. Further, age related prevalence of persistent pain appears to be much more common in the elderly associated with functional limitations and difficulty in performing daily life activities. Chronic persistent low back and neck pain is seen in 25% to 60% of patients, one-year or longer after the initial episode. Spinal pain is associated with significant economic, societal, and health impact. Estimates and patterns of productivity losses and direct health care expenditures among individuals with back and neck pain in the United States continue to escalate. Recent studies have shown significant increases in the prevalence of various pain problems including low back pain. Frequent use of opioids in managing chronic non-cancer pain has been a major issue for health care in the United States placing a significant strain on the economy with the majority of patients receiving opioids for chronic pain necessitating an increased production of opioids, and escalating costs of opioid use, even with normal intake. The additional costs of misuse, abuse, and addiction are enormous. Comorbidities including psychological and physical conditions and numerous other risk factors are common in spinal pain and add significant complexities to the interventionalist’s clinical task. This section of the American Society of Interventional Pain Physicians (ASIPP)/EvidenceBased Medicine (EBM) guidelines evaluates the epidemiology, scope, and impact of spinal pain and its relevance to health care interventions. Key words: Chronic pain, chronic spinal pain, chronic low back pain, chronic neck pain, chronic thoracic pain, prevalence, health care utilization, loss of productivity, interventional techniques, surgery, comorbid factors, socioeconomic effects, health care impact

scholarly journals The Added Value of Subcutaneous Peripheral Nerve Field Stimulation Combined with SCS, as Salvage Therapy, for Refractory Low Back Pain Component in Persistent Spinal Pain Syndrome Implanted Patients: A Randomized Controlled Study (CUMPNS Study) Based on 3D-Mapping Composite Pain Assessment

2021 ◽  
Author(s):  
Philippe Rigoard ◽  
Amine Ounajim ◽  
Lisa Goudman ◽  
Benedicte Bouche ◽  
Manuel Roulaud ◽  
...  
Keyword(s):  
Back Pain ◽  
Peripheral Nerve ◽  
Salvage Therapy ◽  
Pain Syndrome ◽  
Spinal Pain ◽  
Added Value ◽  
Controlled Study ◽  
Field Stimulation ◽  
Peripheral Nerve Field Stimulation ◽  
Spinal Pain Syndrome

While Spinal Cord Stimulation (SCS) provides satisfaction to almost 2/3 of Persistent Spinal Pain Syndrome-Type 2 (PSPS-T2) patients implanted for refractory chronic back and/or leg pain when not adequately addressed the back pain component, leaves patients in a therapeutic cul-de-sac. Peripheral Nerve field Stimulation (PNfS) has shown interesting results addressing back pain in the same population. Far from placing these two techniques in opposition, we suggest that these approaches could be combined to better treat PSPS-T2 patients. We designed a RCT (CUMPNS), with a 12-month follow-up, to assess the potential added value of PNfS, as a salvage therapy, in PSPS-T2 patients experiencing a “Failed SCS Syndrome” in the back pain component. Fourteen patients were included in this study and randomized into 2 groups (“SCS + PNfS” group/n=6 vs “SCS only” group/n=8). The primary objective of the study was to compare the percentage of back pain surface decrease after 3 months, using a computerized interface to obtain quantitative pain mappings, combined with multi-dimensional SCS outcomes. Back pain surface decreased significantly greater for the ”SCS+PNfS” group (80.2% ± 21.3%) compared to the “SCS only” group (13.2% ± 94.8%) (p=0.012), highlighting the clinical interest of SCS+PNfS, in cases where SCS fails to address back pain.

scholarly journals Effectiveness of treatments for acute and subacute mechanical non-specific low back pain: a systematic review with network meta-analysis

2021 ◽  
pp. bjsports-2020-103596
Author(s):  
Silvia Gianola ◽  
Silvia Bargeri ◽  
Gabriele Del Castillo ◽  
Davide Corbetta ◽  
Andrea Turolla ◽  
...  
Keyword(s):  
Systematic Review ◽  
Low Back Pain ◽  
Back Pain ◽  
Meta Analysis ◽  
Muscle Relaxants ◽  
Low Back ◽  
Eligibility Criteria ◽  
Experienced Pain ◽  
Inflammatory Drugs

ObjectiveTo assess the effectiveness of interventions for acute and subacute non-specific low back pain (NS-LBP) based on pain and disability outcomes.DesignA systematic review of the literature with network meta-analysis.Data sourcesMedline, Embase and CENTRAL databases were searched from inception until 17 October 2020.Eligibility criteria for selecting studiesRandomised clinical trials (RCTs) involving adults with NS-LBP who experienced pain for less than 6 weeks (acute) or between 6 and 12 weeks (subacute).ResultsForty-six RCTs (n=8765) were included; risk of bias was low in 9 trials (19.6%), unclear in 20 (43.5%), and high in 17 (36.9%). At immediate-term follow-up, for pain decrease, the most efficacious treatments against an inert therapy were: exercise (standardised mean difference (SMD) −1.40; 95% confidence interval (CI) −2.41 to –0.40), heat wrap (SMD −1.38; 95% CI −2.60 to –0.17), opioids (SMD −0.86; 95% CI −1.62 to –0.10), manual therapy (SMD −0.72; 95% CI −1.40 to –0.04) and non-steroidal anti-inflammatory drugs (NSAIDs) (SMD −0.53; 95% CI −0.97 to –0.09). Similar findings were confirmed for disability reduction in non-pharmacological and pharmacological networks, including muscle relaxants (SMD -0.24; 95% CI -0.43 to -0.04). Mild or moderate adverse events were reported in the opioids (65.7%), NSAIDs (54.3%) and steroids (46.9%) trial arms.ConclusionWith uncertainty of evidence, NS-LBP should be managed with non-pharmacological treatments which seem to mitigate pain and disability at immediate-term. Among pharmacological interventions, NSAIDs and muscle relaxants appear to offer the best harm–benefit balance.

scholarly journals The individual characteristics of the patients with nonspecific back pain aff ecting the dynamics of pain syndrome in the treatment with non-steroidal anti-inflammatory drugs

2020 ◽  
pp. 21-25
Author(s):  
Iryna Maslova ◽  
Natalia Mykhailovska ◽  
Oleg Devinyak ◽  
Vladyslav Moseiko ◽  
Tetiana Slobodin
Keyword(s):  
Back Pain ◽  
Interleukin 1 ◽  
Pain Syndrome ◽  
Interleukin 10 ◽  
Individual Characteristics ◽  
Efficacy And Safety ◽  
Analog Scale ◽  
Inflammatory Drugs ◽  
Anti Inflammatory ◽  
The Individual

The effect of nonsteroidal anti-inflammatory drugs (NSAIDs) in the treatment of patients with non-specific back pain is variable, from complete ineffectiveness to the occurrence of side effects. The eff ect of NSAIDs is affected by various factors, including individual characteristics of the patient. The aim of the study was to improve the diagnostic approach to patients with non-specific back pain to identify individual indicators that can affect the efficacy and safety of NSAID therapy. The study involved 139 patients — men and women aged 30 to 60 years — with acute nonspeci fic back pain. All patients took meloxicam or celecoxib for 10 days, then observed during 90 days. On the 1st, 10th, 30th and 90th days the patients were assessed on scales — Visual Analog Scale ( VAS), Beck Depression Inventory. In the 1st and 10th days in 20 patients we determined the levels of interleukin 1 (IL-1β), interleukin 6 (IL-6), interleukin 10 (IL-10). The patients with arterial hypertension (p = 0,0053), diabetes (p = 0.04), depression (p = 0.01) had significantly worse treatment outcomes. Reduction in the levels of IL-1β and the ratio IL-6/IL-10 led to a significant reduction in pain intensity in patients with back pain. The prescription of NSAIDs for patients with back pain should be assessed from the perspective of the individual patient, including the presence of comorbidity, emotional or genetic markers, and so on, which should increase the efficiency and safety of NSAIDs treatment. Keywords: non-steroidal anti-inflammatory drugs, back pain, CYP2C9 genetic polymorphism, cytokines IL-1, IL-6/IL-10

scholarly journals The Added Value of Subcutaneous Peripheral Nerve Field Stimulation Combined with SCS, as Salvage Therapy, for Refractory Low Back Pain Component in Persistent Spinal Pain Syndrome Implanted Patients: A Randomized Controlled Study (CUMPNS Study) Based on 3D-Mapping Composite Pain Assessment

2021 ◽  
Vol 10 (21) ◽  
pp. 5094
Author(s):  
Philippe Rigoard ◽  
Amine Ounajim ◽  
Lisa Goudman ◽  
Benedicte Bouche ◽  
Manuel Roulaud ◽  
...  
Keyword(s):  
Back Pain ◽  
Peripheral Nerve ◽  
Salvage Therapy ◽  
Pain Syndrome ◽  
Spinal Pain ◽  
Added Value ◽  
Controlled Study ◽  
Field Stimulation ◽  
Peripheral Nerve Field Stimulation ◽  
Spinal Pain Syndrome

While Spinal Cord Stimulation (SCS) provides satisfaction to almost 2/3 of Persistent Spinal Pain Syndrome-Type 2 (PSPS-T2) patients implanted for refractory chronic back and/or leg pain, when not adequately addressed the back pain component, leaves patients in a therapeutic cul-de-sac. Peripheral Nerve field Stimulation (PNfS) has shown interesting results addressing back pain in the same population. Far from placing these two techniques in opposition, we suggest that these approaches could be combined to better treat PSPS-T2 patients. We designed a RCT (CUMPNS), with a 12-month follow-up, to assess the potential added value of PNfS, as a salvage therapy, in PSPS-T2 patients experiencing a “Failed SCS Syndrome” in the back pain component. Fourteen patients were included in this study and randomized into 2 groups (“SCS + PNfS” group/n = 6 vs. “SCS only” group/n = 8). The primary objective of the study was to compare the percentage of back pain surface decrease after 3 months, using a computerized interface to obtain quantitative pain mappings, combined with multi-dimensional SCS outcomes. Back pain surface decreased significantly greater for the ”SCS + PNfS” group (80.2% ± 21.3%) compared to the “SCS only” group (13.2% ± 94.8%) (p = 0.012), highlighting the clinical interest of SCS + PNfS, in cases where SCS fails to address back pain.

scholarly journals Neck pain: a clinical analysis of causes and therapy priorities

2019 ◽  
Vol 11 (2S) ◽  
pp. 69-75 ◽  
Author(s):  
G. R. Tabeeva
Keyword(s):  
Back Pain ◽  
Neck Pain ◽  
Pain Syndrome ◽  
Detailed Examination ◽  
Clinical Analysis ◽  
Randomized Controlled Studies ◽  
Common Causes ◽  
Important Landmark ◽  
Inflammatory Drugs ◽  
The Common

Neck pain is one of the common causes of maladjustment. Acute neck pain in most cases regresses independently in the period of a few weeks to months; however, it recurs in half of cases. Although the potential specific causes of cervicalgia are rare; nevertheless, in some cases the patient should undergo a detailed examination that is based on the identification of red flags and can optimize a search for the cause of pain syndrome. A consideration of the important principles of classifying pain in acute and chronic, neuropathic and nociceptive pain can serve as an important landmark in choosing the optimal treatment strategy for a patient. Unlike low back pain, neck pain has been investigated in an insufficient number of randomized controlled studies, which makes this analysis extremely relevant. The paper discusses the use of nonsteroidal anti-inflammatory drugs for back pain and the efficacy and safety of celecoxib.

scholarly journals Tolperisone in the treatment of acute and chronic nonspecific back pain

2020 ◽  
Vol 12 (4) ◽  
pp. 137-142
Author(s):  
V. A. Golovacheva ◽  
A. A. Golovacheva ◽  
O. E. Zinovyeva ◽  
V. L. Golubev
Keyword(s):  
Clinical Trials ◽  
Back Pain ◽  
Randomized Trial ◽  
Muscle Relaxant ◽  
Large Scale ◽  
Muscle Relaxants ◽  
Good Tolerance ◽  
Vertebral Canal ◽  
Canal Stenosis ◽  
Inflammatory Drugs

Nonspecific back pain (NBP) is one of the most common reasons to see a neurologist or therapist. Acute (<4 weeks' duration), subacute (4 to 12 weeks), and chronic (>12 weeks) NBPs are recognized. The diagnosis of NBP is based on anamnestic data, somatic, neurological, and neurologic-and-orthopedic examination findings and on the exclusion of the specific causes of back pain, discogenic radiculopathy, and vertebral canal stenosis. Nonsteroidal anti-inflammatory drugs (NSAIDs) and muscle relaxants are used in the pharmacotherapy of acute, subacute, and chronic NBP. Tolperisone is widely used as a muscle relaxant in Russia and in the countries of Europe and Asia. Clinical trials have shown the efficacy and good tolerance of tolperisone used alone and in combination with NSAIDs for NBP. The review presents clinical recommendations from different countries on the use of muscle relaxants in the treatment of acute and chronic NBP. It is concluded that a large-scale qualitative randomized trial should be conducted to investigate the efficacy of muscle relaxants, tolperisone in particular, in the treatment of acute, subacute, and chronic NBP.

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