scholarly journals Psychological aspects in the rehabilitation of patients with chronic back pain

2020 ◽  
Vol 19 (2) ◽  
pp. 95-100
Author(s):  
A. A. Voropaev ◽  
M. Yu. Gerasimenko ◽  
G. E. Ivanova
Keyword(s):  
Neural Network ◽  
Chronic Pain ◽  
Back Pain ◽  
Pain Syndrome ◽  
Structural Theory ◽  
Surgical Approaches ◽  
Neural Network Modeling ◽  
Neurophysiological Study ◽  
Neurophysiological Studies ◽  
The Right

Background. The relevance of the work is associated with the high prevalence and socio-economic significance of chronic pain. The number of analgesics consumed in the world is estimated in the tens of tonns. Hardware effects, including neurosurgical interventions, are not always effective and are associated with many side effects of complications. Existing therapeutic and surgical approaches to the treatment of chronic pain require additions. In this regard, the information and structural theory of pain was developed, revealing the information processes occurring in the Central nervous system against the background of chronic pain, as well as the theory of psychological types and information metabolism. In this case, it is easier not to look for the right solution, but to create a mechanism that will come up with a method for finding the right solution. A neural network is one of the ways to implement artificial intelligence (AI). It studies methods for building algorithms that can learn independently. This is necessary if there is no clear solution to any problem. Aims: based on the comparison of data from neuropsychological, clinical and neurophysiological studies, as well as mathematical (neural network) modeling of chronic pain, to identify information and structural justification and practical application of psychoalgology. Methods. A total of A total of 105 patients diagnosed with Dorsopathy (M54.4; M51.1, M54.1) were studied. 50 men and 55 women, men: average age 49 0.5 years; women: average age 52 1.6 years. Assessment of the level of reactive and personal anxiety using the adapted SpielbergerHanin questionnaire, the SAN test, and the assessment of vegetative status using the vegetative questionnaire by A.M. Wein. Neuroimaging research: CT, MRI of the brain and spine for diagnostic purposes. The neurophysiological study consisted of EEG, TCD, duplex scanning of the craniocervical junction vessels. For a more detailed assessment, a neural network analyzer of lumbar pain was used, which allows predicting its course. Results. A clinical and neurophysiological study of patients with back pain revealed that, along with other disorders of cerebral neurodynamics, a large role is played by lateralization of cerebral neurodynamics (asymmetry), which is manifested by more pronounced changes in the EEG in the contralateral hemisphere. When studying the subjective state of patients, two main types of disorders were distinguished: the type of associated and the type of non-associated mental disorders. As a result of the analysis of mathematical (neural network) algorithms of pain syndromes, clinical and neurophysiological studies, new principles of chronization of the pathological process with the transformation of the pain syndrome into an independent psychological disease were formulated. ALGIC DISEASE is characterized by a pronounced clinical polymorphism due to complex information-structural interactions of dominant and subdominant zones and characterized by: 1) heterogeneity and chaotic spatial parameters of pain in relation to the zones of innervation of nociogenic structures; 2) non-topological time parameters of peripheral and Central sensitization with increased pain from instant to prolonged; 3) mutual suppression, displacement, migration of pain centers; 4) changing the monocausal dependence of the polycausal pain syndrome with the possibility of a reverse process in the process of regional integrative measures with a multidisciplinary approach; 5) the relationship of chronic pain with pronounced cognitive, emotional and vegetative reactions. Conclusions. Based on the information and structural theory of pain, the results of research and the proposed psychoalgological approach, the principles of building a rehabilitation program for patients with chronic pain are formulated, which consists in a complex effect on nociogenic structures of types 1, 2 and 3 in combination with the modification of patient behavior through individually selected psychotherapeutic techniques.

The phenomenon of migration of nociogenic structures in the human sensor-algic system (results of clinical and neurophysiological studies and morphological experiments)

2020 ◽  
pp. 16-24
Author(s):  
Maksim Vladimirovich Shpagin ◽  
Mikhail Valerievich Kolesnikov ◽  
Olga Yurievna Khutorskaya ◽  
Dmitriy Evgenievich Timoshkin ◽  
Artem Andreevich Belikin ◽  
...  
Keyword(s):  
Chronic Pain ◽  
Nervous System ◽  
Pain Syndrome ◽  
Point Of View ◽  
Chronic Pain Syndrome ◽  
Integrative Therapy ◽  
Neurophysiological Studies ◽  
Positive Results ◽  
Structural Point ◽  
Chronicity Of Pain

From the informational and structural point of view, the chronicity of pain is associated with the migration of nociogenic zones. The phenomenon of migration is based on the mechanisms of neuroplasticity, compensatory-restorative processes in the nervous system. On the basis of the phenomenon of migration of the nociogenic zone, a system of regional integrative therapy of chronic pain syndrome has been developed. Recommendations on the advisability of invasive shutdown of the nociogenic zone using invasive pharmacotherapy or surgical denervation have been proposed. In the course of studying the characteristics of chronic pain, depending on the duration of the disease, a direct proportional correlation was revealed between the increase in the components of pain and the duration of the pain syndrome, which can be explained by the increase in the number of nociogenic structures that form the complexity and stability of the pain syndrome. Thus, the necessity of neurodestructive interventions increases for attaining positive results. An important area of therapy is the inclusion of psychotherapy, pharmacotherapy and neuromodulation into the system of regional-integrative influence.

scholarly journals Complex Regional Pain Syndrome and Failed Back Surgery Syndrome With Failed High-Frequency Spinal Cord Stimulation Salvaged With Arthrodesis Revision Surgery and Burst Therapy

Neurosurgery ◽  
2019 ◽  
Vol 66 (Supplement_1) ◽  
Author(s):  
Erin McCormack ◽  
Mansour H Mathkour ◽  
Lora Wallis Kahn ◽  
Maged Guirguis ◽  
Gassan Chaiban ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Chronic Pain ◽  
Back Pain ◽  
Pain Relief ◽  
High Frequency ◽  
Pain Syndrome ◽  
Failed Back Surgery Syndrome ◽  
Foot Pain ◽  
Failed Back Surgery ◽  
Back Surgery

Abstract INTRODUCTION Complex regional pain syndrome (CRPS) is a disabling form of constant and intense chronic pain involving a limb. Failed back surgery syndrome (FBSS) is chronic back pain following back surgery. Burst stimulation is a novel concept applied recently to treat chronic pain through spinal cord stimulation (SCS). The impulses are thought to travel to the thalamus to treat sensory, affective, and attentional components of neuropathic pain by targeting both the somatosensory cortex and the limbic system. METHODS A 50-yr-old female presented 1 yr after L5-S1 posterior instrumentation and posterolateral arthrodesis for spondylolisthesis with disabling Type I CRPS of her left foot and back pain. Postoperative improvement in back pain was noted but her left leg pain became worse despite SCS reprogramming. Two months later, she underwent placement of a different paddle lead at T12 and a new pulse generator using burst therapy. This resulted in complete resolution of foot pain. She remains pain-free 5 mo postoperatively. RESULTS Our patient underwent a T9-T10 high frequency (10 kHz) SCS trial followed by permanent paddle lead placement at T9-10 which provided more than 50% foot pain relief resulting in improved range of motion. However, worsening back pain and pseudoarthrosis mandated a revision of her prior arthrodesis 6 mo after SCS surgery. CONCLUSION In selected patients with FBSS and CRPS, revision of arthrodesis combined with SCS may be needed to achieve adequate pain relief. Burst therapy may be superior to high frequency stimulation in select patients.

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 FACTORS OF INFLUENCE ON PAIN INTENSITY AND FUNCTIONAL ACTIVITY OF PATIENTS WITH BACK PAIN OF DIFFERENT LOCALIZATION

2019 ◽  
pp. 35-43
Author(s):  
I. G. Maslova ◽  
N. O. Mykhailovska ◽  
T. M. Slobodin
Keyword(s):  
Mental Health ◽  
Chronic Pain ◽  
Back Pain ◽  
Pain Syndrome ◽  
Anxiety And Depression ◽  
Vital Activity ◽  
Lower Back ◽  
Sf 36 ◽  
Factors Of Influence ◽  
High Level

In order to identify the probable factors of the effect on the intensity of the pain syndrome and the parameters of the functioning of patients with back pain, depending on the location of the pain syndrome and concomitant pathology, 139 patients with non-specific back pain who were in inpatient treatment in the medical and sanitary part of JSC "Motor -Sich "with the first detected acute pain syndrome and acute exacerbation of chronic. The results of the study revealed a decrease in the level of physical functioning, deterioration of vital activity and the state of general and mental health (on the scale of SF-36) in patients with exacerbation of chronic pain, the lowest indicators of vital activity, social functioning, mental health and a high level of anxiety and depression - in patients with cervical and cranial localization of pain syndrome, despite the fact that patients with localized pain in the lower back are markedly higher levels of pain not only for YES, but also zg BP bottom axis scale SF-36. Patients with a combination of arterial hypertension and diabetes have been shown to have chronic pain syndrome.

scholarly journals FACTORS OF INFLUENCE ON PAIN INTENSITY AND FUNCTIONAL ACTIVITY OF PATIENTS WITH BACK PAIN OF DIFFERENT LOCALIZATION

2019 ◽  
pp. 35-43
Author(s):  
I. G. Maslova ◽  
N. O. Mykhailovska ◽  
T. M. Slobodin
Keyword(s):  
Mental Health ◽  
Chronic Pain ◽  
Back Pain ◽  
Pain Syndrome ◽  
Anxiety And Depression ◽  
Vital Activity ◽  
Lower Back ◽  
Sf 36 ◽  
Factors Of Influence ◽  
High Level

In order to identify the probable factors of the effect on the intensity of the pain syndrome and the parameters of the functioning of patients with back pain, depending on the location of the pain syndrome and concomitant pathology, 139 patients with non-specific back pain who were in inpatient treatment in the medical and sanitary part of JSC "Motor -Sich "with the first detected acute pain syndrome and acute exacerbation of chronic. The results of the study revealed a decrease in the level of physical functioning, deterioration of vital activity and the state of general and mental health (on the scale of SF-36) in patients with exacerbation of chronic pain, the lowest indicators of vital activity, social functioning, mental health and a high level of anxiety and depression - in patients with cervical and cranial localization of pain syndrome, despite the fact that patients with localized pain in the lower back are markedly higher levels of pain not only for YES, but also zg BP bottom axis scale SF-36. Patients with a combination of arterial hypertension and diabetes have been shown to have chronic pain syndrome.

Postlaminectomy Syndrome

2018 ◽  
Author(s):  
Kenneth D. Candido ◽  
Tatiana Tverdohleb ◽  
Nebojsa Nick Knezevic
Keyword(s):  
Back Pain ◽  
Clinical Judgment ◽  
Myofascial Pain ◽  
Subsequent Development ◽  
Pain Syndrome ◽  
Myofascial Pain Syndrome ◽  
Lumbar Spine Surgery ◽  
Low Back ◽  
Back Surgery ◽  
The Right

Postlaminectomy syndrome is persistent or recurrent back pain after otherwise anatomically successful lumbar spine surgery. A dramatic increase in the number of low back surgeries has been observed since 1997, with an increased incidence of pain after low back surgery in the range of 5% to 74.6%. The mechanisms contributing to back pain are muscle damage during surgery, muscle spasm, and inflammation, with subsequent development of myofascial pain syndrome as well as other typical and atypical back pain generators. Diagnosis is based primarily on history and physical examination, as well as results of imaging (preoperative and postoperative). Treating postlaminectomy syndrome is challenging, due to lack of evidence-based clinical guidelines. Pharmacologic treatment in combination with interventional management sometimes is not enough, and choosing the right candidates for revision and reoperation surgery is mainly based on the surgeon’s experience and best clinical judgment. In certain circumstances, spinal cord stimulation can achieve better results than reoperation.

scholarly journals Current trends and therapies in orchialgia management

2021 ◽  
Vol 13 ◽  
pp. 175628722110264
Author(s):  
Kevin Campbell ◽  
Larry Lipshultz
Keyword(s):  
Chronic Pain ◽  
Pain Management ◽  
Pain Syndrome ◽  
Surgical Approaches ◽  
Invasive Procedures ◽  
Detailed History ◽  
Testicular Pain ◽  
Current Trends ◽  
Methods Of Treatment ◽  
Multiple Therapy

The management of pain is a complex condition that will be encountered by most practicing clinicians. In the genitourinary community, testicular pain may be classified as acute or chronic. Initial evaluation of chronic groin and scrotal content pain (CGSCP) begins with a detailed history and physical examination to elucidate the presenting pathology. Multiple therapy algorithms have been proposed with no definitive consensus; however, most begin with conservative intervention and medical management prior to advancing to more invasive procedures. Surgical approaches may range from reconstruction, as in vasovasostomy for post-vasectomy pain syndrome, to excision of the offending agent, as in epididymectomy. This review seeks to focus on chronic pain in the genitourinary community and review techniques of pain management in the current intervention for orchialgia, as well as identify future methods of treatment.

scholarly journals A new look at back pain treatment in light of the latest ESCEO guidelines

2020 ◽  
Vol 12 (6) ◽  
pp. 90-95
Author(s):  
O. A. Shavlovskaya ◽  
I. A. Zolotovskaya ◽  
Yu. A. Prokofyeva
Keyword(s):  
Chronic Pain ◽  
Back Pain ◽  
Pain Treatment ◽  
Pain Syndrome ◽  
Modern Medicine ◽  
Economic Aspects ◽  
Immune Disorders ◽  
Inflammatory Drugs ◽  
Disease Modifying

Chronic pain (CP) is still one of the urgent problems of modern medicine. The paper provides a review of the main pharmacotherapeutic approaches from the standpoint of the European Society for Clinical and Economic Aspects of Osteoporosis and Osteoarthritis (ESCEO) guidelines. When preparing this material, the authors have analyzed the publications available in the resources: PubMed, EMBASE, Cochrane, and еLIBRARY. The paper presents the main pathogenetic mechanisms of pain syndrome development in osteoarthritis (OA), including synovial inflammation and associated immune disorders. It considers the types of development of pain syndrome and the main prognostic outcomes according the mechanism of pain, providing a rationale for the use of nonsteroidal anti-inflammatory drugs (NSAIDs) and/or chondroprotectors (CPs). In accordance with the ESCEO guidelines, it is noted that when starting OA therapy, CPs should be considered as the first step (in their long-term prescription and pharmaceutical quality), then NSAIDs should be added (topically), then (if ineffective) orally, by excluding patients with hip OA. It is known that the intramuscular administration of CPs (chondroitin sulfate (CS) in particular) can increase their bioavailability. The use of glucosamine sulfate (GS) is recommended for patients over 60 years of age. According to the recommendations of the 2019 ESCEO experts, CS and GS should be used as a disease-modifying OA drug from the first step and at all subsequent stages.

scholarly journals Interactions between Musculoskeletal Dysfunction, Emotional Distress and Cytokines in Patients with Chronic Low Back Pain Syndrome

2020 ◽  
Vol 1 (6) ◽  
Author(s):  
Daina Šmite ◽  
Gunta Ancāne ◽  
Pēteris Tretjakovs
Keyword(s):  
Chronic Pain ◽  
Low Back Pain ◽  
Motor Control ◽  
Back Pain ◽  
Lumbar Spine ◽  
Emotional Distress ◽  
Chronic Low Back Pain ◽  
Pain Syndrome ◽  
Low Back

Despite different treatment methods, for approximately 30% of patients acute back pain turns into chronic pain syndrome which accompanied by disability creates remarkable material damage to patients themselves, to health care and to the society. The aim of the study was to analyse the interaction between musculoskeletal dysfunction, emotional distress and related disability, and their underlying neuroimonological pathophysiological mechanisms, in patients with chronic low back pain syndrome. The subjects were 43 patients, mean age 45 ± 1.3 years, with clinical diagnosis of lumbar spine disk pathology with chronic low back pain syndrome and present manifestation of emotional distress. All patients had complex assessment that included lumbar spine and pelvic motor control tests, muscle and ligaments palpation tests, Hospital Anxiety and Depression Scale, PF subscale of SF-36 survey, Visual Analogue Scale, immunological analysis of blood to detect the level of cytokines. The results approved interaction (p < 0.05) between motor control and palpation tests results, emotional distress features and pain intensity. Therefore musculoskeletal dysfunction in patients with chronic low back pain is connected both with physical and psycho-emotional factors, which has to be taken into account both when evaluating functional tests and during the treatment process. Clinically important finding is that limitation in physical activities in chronic low back pain patients are affected both by motor control impairment and depression symptoms, as well as pain intensity, which has to be remembered during rehabilitation planning process. Some of cytokines (TNF-a, IL-6, IL-8, IL-10, IL-2) correlated with emotional disturbances physical disturbances, pain syndrome characteristics and physical disability in patients with chronic low back pain. IL-10 and IL-8 appeared to be two of the most characteristic cytokines. It is interesting to note, that in literature studies have approved the role of IL-10 in the pathogenesis of chronic, widespread pain syndrome, but IL-8 has been shown in the role of the pathogenesis of radicular pain syndrome in patients with lumbar spine disk pathology [1, 2]. Studies of cytokines extend the understanding of bio-psycho-social aspects of chronic pain syndrome pathogenesis therefore improving process of assessment, clinical reasoning and therapy.Keywords: musculoskeletal dysfunction, emotional distress, chronic pain, cytokines.

scholarly journals Optimization of the management of a patient with a backache (with clinical observation)

2019 ◽  
pp. 43-50
Author(s):  
D. O. Rozhkov ◽  
O. E. Zinov’yeva ◽  
I. M. Vikhlyantsev ◽  
G. Z. Mikhaylova ◽  
A. D. Ulanova ◽  
...  
Keyword(s):  
Chronic Pain ◽  
Back Pain ◽  
Cognitive Behavioural Therapy ◽  
Chronic Back Pain ◽  
Pain Syndrome ◽  
Behavioural Therapy ◽  
Pathological Process ◽  
Economic Losses ◽  
Prolonged Stay ◽  
Cognitive Behavioural

Back pain in terms of socio-economic losses over the past 5 years has come to the first place among the causes of disability, and therefore the problem of rapid effective anesthesia and rehabilitation of this large group of patients is topical. In most cases, the main sources of back pain are the structures of the musculoskeletal system, and the reasons are their microtraumatization due to sudden unprepared movements, prolonged stay in a static position, heavy physical labor. The task of clinical and instrumental examination is to exclude specific causes of dorsalgia. It is also important to present the results of the survey in an accessible form, in particular to correctly interpret the data from neuroimaging research methods. Adequate anaesthesia for acute back pain, informing the patient about the favorable prognosis of the disease and early motor activation are essential to prevent the transition of the physiological feeling of pain into the pathological process - chronic pain syndrome. When dealing with chronic pain, the interaction of specialists of different profiles in the multidisciplinary team is required. Kinesiotherapy, ergotherapy, cognitive-behavioural therapy are the main methods of non-drug treatment of lower back painIt is recommended that the patient maintains the usual level of physical activity and then increases it. It is necessary to teach the patient to correctly perform movements in the social, professional and domestic spheres, to explain how to avoid unsafe movements that can provoke dorsalgia. The article presents the observation of a patient with chronic back pain. Success in treatment has been achieved through effective anesthesia through rational selection of non-steroidal anti-inflammatory drugs (Dexalgin), local administration of local anesthetics to overcome kinesiophobia, and a combination of cognitive-behavioural therapy, kinesiotherapy, and ergotherapy.

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