A Novel Multi-dimensional Clinical Response Index Dedicated to Improving Global Assessment of Pain in Patients with Persistent Spinal Pain Syndrome After Spinal Surgery, Based on a Real-life Prospective Multicentric Study (PREDIBACK) and Machine Learning

The multidimensionality of chronic pain forces us to look beyond isolated pain assessment such as pain intensity, which does not consider multiple key parameters, particularly in patients suffering from post-operative Persistent Spinal Pain Syndrome (PSPS-T2). Our ambition was to provide a novel Multi-dimensional Clinical Response Index (MCRI), including not only pain intensity but also functional capacity, anxiety-depression, quality of life and objective quantitative pain mapping assessments, the objective being to capture patient condition instantaneously, using machine learning techniques. Two hundred PSPS-T2 patients were enrolled in a real-life observational prospective PREDIBACK study with 12-month follow-up and received various treatments. From a multitude of questionnaires/scores, specific items were combined using exploratory factor analyses to create an optimally accurate MCRI; as a single composite index, using pairwise correlations between measurements, it appeared to better represent all pain dimensions than any other classical score. It appeared to be the best compromise among all existing indexes, showing the highest sensitivity/specificity related to Patient Global Impression of Change (PGIC). Novel composite indexes could help to refine pain assessment by changing the physician’s perception of patient condition on the basis of objective and holistic metrics, and by providing new insights to therapy efficacy/patient outcome assessments, before ultimately being adapted to other pathologies.

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A Novel Multi-Dimensional Clinical Response Index Dedicated to Improving Global Assessment of Pain in Patients with Persistent Spinal Pain Syndrome after Spinal Surgery, Based on a Real-Life Prospective Multicentric Study (PREDIBACK) and Machine Learning Techniques

Journal of Clinical Medicine ◽

10.3390/jcm10214910 ◽

2021 ◽

Vol 10 (21) ◽

pp. 4910

Author(s):

Philippe Rigoard ◽

Amine Ounajim ◽

Lisa Goudman ◽

Pierre-Yves Louis ◽

Yousri Slaoui ◽

...

Keyword(s):

Machine Learning ◽

Pain Intensity ◽

Clinical Response ◽

Real Life ◽

Pain Syndrome ◽

Spinal Pain ◽

Machine Learning Techniques ◽

Response Index ◽

Learning Techniques ◽

Spinal Pain Syndrome

The multidimensionality of chronic pain forces us to look beyond isolated assessment such as pain intensity, which does not consider multiple key parameters, particularly in post-operative Persistent Spinal Pain Syndrome (PSPS-T2) patients. Our ambition was to produce a novel Multi-dimensional Clinical Response Index (MCRI), including not only pain intensity but also functional capacity, anxiety-depression, quality of life and quantitative pain mapping, the objective being to achieve instantaneous assessment using machine learning techniques. Two hundred PSPS-T2 patients were enrolled in the real-life observational prospective PREDIBACK study with 12-month follow-up and received various treatments. From a multitude of questionnaires/scores, specific items were combined, as exploratory factor analyses helped to create a single composite MCRI; using pairwise correlations between measurements, it appeared to more accurately represent all pain dimensions than any previous classical score. It represented the best compromise among all existing indexes, showing the highest sensitivity/specificity related to Patient Global Impression of Change (PGIC). Novel composite indexes could help to refine pain assessment by informing the physician’s perception of patient condition on the basis of objective and holistic metrics, and also by providing new insights regarding therapy efficacy/patient outcome assessments, before ultimately being adapted to other pathologies.

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Persistent Spinal Pain Syndrome Type 2 (PSPS-T2), a Social Pain? Advocacy for a Social Gradient of Health Approach to Chronic Pain

Journal of Clinical Medicine ◽

10.3390/jcm10132817 ◽

2021 ◽

Vol 10 (13) ◽

pp. 2817

Author(s):

Nicolas Naiditch ◽

Maxime Billot ◽

Maarten Moens ◽

Lisa Goudman ◽

Philippe Cornet ◽

...

Keyword(s):

Chronic Pain ◽

Pain Syndrome ◽

Spinal Pain ◽

Social Gradient ◽

Syndrome Type ◽

Multicentric Study ◽

The Social ◽

Failed Back Surgery ◽

Spinal Pain Syndrome

The Social Gradient of Health (SGH), or position in the social hierarchy, is one of the major determinants of health. It influences the development and evolution of many chronic diseases. Chronic pain dramatically affects individual and social condition. Its medico-economic impact is significant and worldwide. Failed Back Surgery Syndrome or Persistent Spinal Pain Syndrome type 2 (PSPS-T2) represents one of its most fascinating and disabling conditions. However, the influence of SGH on PSPS-T2 has been poorly explored. We designed a prospective multicentric study (PREDIBACK study) to assess the SGH prevalence, and to examine its association with medical and psychological variables, in PSPS-T2 patients. This study included 200 patients to determine the SGH association with pain (NPRS), Quality of life (EQ-5D-5L), kinesiophobia (FABQ-Work), catastrophism (CSQ), and functional capacity (ODI). Around 85.3% of PSPS-T2 patients in our study had low SGH. Low SGH patients had a higher FABQ-Work and CSQ-Catastrophizing score than high SGH patients (p < 0.05). High SGH patients have a higher ODI score than low SGH patients (p < 0.10). Our results suggest that SGH is a relevant factor to guide prevention, research, and ultimately intervention in PSPS-T2 patients and could be more widely transposed to chronic pain.

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Persistent Spinal Pain Syndrome: a proposal for Failed Back Surgery Syndrome and ICD-11

Pain Medicine ◽

10.1093/pm/pnab015 ◽

2021 ◽

Author(s):

Nick Christelis ◽

Brian Simpson ◽

Marc Russo ◽

Michael Stanton-Hicks ◽

Giancarlo Barolat ◽

...

Keyword(s):

Chronic Pain ◽

Spine Surgery ◽

Pain Syndrome ◽

Spinal Pain ◽

Failed Back Surgery Syndrome ◽

Medical Professionals ◽

Failed Back Surgery ◽

Back Surgery ◽

Spinal Pain Syndrome

Abstract Objective For many medical professionals dealing with patients with persistent pain following spine surgery, the term failed back surgery syndrome (FBSS) as a diagnostic label is inadequate, misleading and potentially troublesome. It misrepresents causation. Alternative terms have been suggested but none has replaced FBSS. The International Association for the Study of Pain (IASP) published a revised classification of chronic pain, as part of the new International Classification of Diseases (ICD-11), which has been accepted by the World Health Organization (WHO). This includes the term Chronic pain after spinal surgery (CPSS), which is suggested as a replacement for FBSS. Methods This article provides arguments and rationale for a replacement definition. In order to propose a broadly applicable yet more precise and clinically informative term, an international group of experts was established. Results 14 candidate replacement terms were considered and ranked. The application of agreed criteria reduced this to a shortlist of four. A preferred option – Persistent spinal pain syndrome – was selected by a structured workshop and Delphi process. We provide rationale for using Persistent spinal pain syndrome and a schema for its incorporation into ICD-11. We propose the adoption of this term would strengthen the new ICD-11 classification. Conclusions This project is important to those in the fields of pain management, spine surgery and neuromodulation, as well as patients labelled with FBSS. Through a shift in perspective it could facilitate the application of the new ICD-11 classification and allow clearer discussion amongst medical professionals, industry, funding organisations, academia, and the legal profession.

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50 challenging spinal pain syndrome cases

Manual Therapy ◽

10.1016/s1356-689x(03)00042-0 ◽

2003 ◽

Vol 8 (4) ◽

pp. 261

Author(s):

Sara Luetchford

Keyword(s):

Pain Syndrome ◽

Spinal Pain ◽

Spinal Pain Syndrome

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Effect of L-arginine in central spinal pain syndrome

Bulletin of Experimental Biology and Medicine ◽

10.1007/bf02433097 ◽

1999 ◽

Vol 127 (2) ◽

pp. 144-147

Author(s):

E. I. Danilova ◽

V. N. Grafova ◽

M. L. Kukushkin ◽

V. A. Zinkevich

Keyword(s):

Pain Syndrome ◽

Spinal Pain ◽

Central Spinal Pain Syndrome ◽

Spinal Pain Syndrome

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OSOBENNOSTI KLINIKI, DIAGNOSTIKI I LEChENIYa ZABOLEVANIY GRUDNOGO I POYaSNIChNOGO OTDELOV POZVONOChNIKA U BEREMENNYKh ZhENShchIN

N.N. Priorov Journal of Traumatology and Orthopedics ◽

10.17816/vto200310131-35 ◽

2003 ◽

Vol 10 (1) ◽

pp. 31-35

Author(s):

E G Skryabin

Keyword(s):

Clinical Manifestations ◽

Pain Syndrome ◽

Spinal Pain ◽

Negative Influence ◽

Spinal Diseases ◽

Spine Deformity ◽

Posterior Surface ◽

Complex Treatment ◽

Moiré Topography ◽

Spinal Pain Syndrome

Examination of 325 pregnants with spinal pain at different terms of gestation was performed. The nature, rate and main clinical manifestations of vertebral pathology are detected. Taking into account impossibility of radiologic examination the shady moire topography of posterior surface of trunk , which exerted no negative influence on fetus, was used for the diagnosis of spine deformity. Complex treatment with nondrug therapy allowed to eliminate or significantly decrease the spinal pain syndrome. Specially elaborated devices for the diagnosis and treatment of spinal diseases in pregnants were used.

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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

10.20944/preprints202109.0031.v1 ◽

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.

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